As diferentes manifestações da heminegligência e sua avaliação clínica / The different manifestations of hemineglect and his clinical evaluation

A heminegligência é caracterizada por comprometimento cognitivo basicamente atencional e está relacionada com pior prognóstico evolutivo. Ela pode ser classificada como heminegligência motora, sensorial, e representacional, ou ainda como peripessoal ou extrapessoal. Sua detecção e avaliação podem ser complexas. A heminegligência é geralmente avaliada por uma variedade de testes de "lápis e papel" que nem sempre avaliam todas as manifestações da síndrome. Assim, o uso de uma bateria de testes é preconizado para uma maior sensibilidade diagnóstica. Somente através de avaliação minuciosa podem-se traçar estratégias de tratamento direcionadas e mais eficazes para cada tipo de heminegligência, e assim, melhorar o prognóstico dos pacientes. Testes quedemonstraram validade, sensibilidade e que foram publicados com valor de corte são sugeridos nessa revisão para melhorar a sensibilidade do diagnóstico e facilitar o exame dos profissionais envolvidos na reabilitação dos pacientes. (AU)

Hemineglect is characterized by a cognitive disorder (attentional) and is related to worse prognosis. Hemineglect may be classified as motor, sensory, and representational, as well as peri-personal or extra-personal. Its detection and assessment can be complex. Hemineglect is usually assessed by a variety of "pencil and paper" tests, even if these tests do not assess all manifestations of the syndrome. Therefore,the use of a battery is recommended. This improves diagnostic sensitivity and specificity. Only through specific assessment can more efficient and targeted strategies of treatment be implemented, improving patients? prognosis. Tests that have shown validity, sensitivity and were published with cut-off scores are suggested in this review to improve the sensitivity of diagnosis and to facilitate the examination by professionals involved in rehabilitation. (AU)

Absence of hemispatial neglect following right hemispherectomy in a 7-year-old girl with neonatal stroke

Neonatal stroke leads to cognitive deficits that may include hemispatial neglect. Hemispatial neglect is a syndrome after stroke that patients fail to be aware of stimuli on the side of space and body opposite a brain lesion. We report here a 7-year-old girl who suffered neonatal right brain stroke and underwent right hemispherectomy due to refractory epilepsy. Post-surgical observation of the child’s behavior and tests did not show any signs of hemispatial neglect. We concluded the spatial attention function of the child with neonatal stroke might be transferred to the contralateral side during early childhood.

Effects of Robot-assisted Upper Limb Training on Hemiplegic Patients

OBJECTIVE: To investigate the effects of short-term robot-assisted upper limb training on hemiplegic patients compared to conventional physical therapy. METHOD: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegic patients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training and conventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventional upper limb physical therapy for 30 min twice a day (Conventional group). All interventions were provided for 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyer assessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthel index-upper extremity (MBI-UE), line bisection test, and Albert test. RESULTS: The Robot group showed significant improvement in FMA-UE (pre: 13.22 +/- 14.20, post: 21.67 +/- 15.84; p = 0.018), MBI-UE (pre: 14.33 +/- 7.42, post: 16.56 +/- 6.95; p = 0.041), and line bisection test (pre: 25.15 +/- 34.48, post: 14.93 +/- 28.38; p = 0.043). The Conventional group showed significant improvement only in MBI-UE (pre: 9.22 +/- 6.06, post: 15.56 +/- 6.19; p = 0.008). The improvement in MBI-UE was larger in the Conventional group than Robot group (6.33 +/- 3.28 vs. 2.22 +/- 2.49; p = 0.014). CONCLUSION: This study suggests that short-term robot-assisted upper limb training may improve upper limb function in hemiplegic patients. However, proper physical therapy may be needed to transfer improved upper limb function to activity of daily living. In addition, goal-directed reaching tasks using a robot are expected to be a treatment option for hemineglect.

Study on the diagnosis and mechanism of hemispatial neglect using different imaging modalities / 中华核医学与分子影像杂志

Hemispatial neglect is a kind of cognitive impairment characterized by failure to report,respond or orient to stimuli presented in ipsi-or contra-lateral space after brain injury,which cannot be attributed to sensory or motor defects.Although there are various diagnosis and assessment methods,none is regarded as standard.The paper and pencil test is commonly used in routine clinical workup.The mechanism is controversial and the most accepted opinion is due to visuospatial attention defect.Imaging study focuses on exploring the functional regions leading to the hemispatial neglect.As functional imaging,SPECT and PET have capability to evaluate the perfusion,glucose metabolism and cellular vitality,which have been found increasingly useful and applicable clinically in the field of diagnosis for cognitive impairment diseases.They are likely to have potential for contribution in the study of hemispatial neglect.

Risk Factor of Visuospatial Neglect: A Study of Association Between Visuospatial Neglect and Anemia

OBJECTIVE: To investigate the correlation between visuospatial neglect and anemia in patients with right cerebral infarction, as well as to identify the risk factor of neglect and furnish preliminary data on rehabilitation management. METHODS: The line bisection test and Albert test were conducted on subjects with right cerebral infarction in order to analyze neglect severity. Multiple linear regression analysis was conducted to investigate correlation between neglect severity and hemoglobin and hematocrit level. Logistic regression analysis was applied to identify the risk factor of neglect. RESULTS: Visuospatial neglect was observed in 33 subjects out of 124. Hemoglobin and hematocrit were not directly correlated with visuospatial neglect severity, whereas infarct size was directly correlated. Subjects with visuospatial neglect were characterized by a large infarct size, a low score in the Mini-Mental State Examination and long hospital stay. CONCLUSION: In this study, visuospatial neglect was found to be uncorrelated with anemia. It implies that emphasis should be placed on the early detection of anemia and neglect in patients with left hemiplegia, the formulation of respective therapeutic plans and improvement of prognosis. The study found that the possibility of a visuospatial neglect occurrence increases with infarct size. In this regard, it is required that visuospatial neglect was detected and treated in the earliest possible stage, notwithstanding the difficulty that lies in the precise measurement of the severity.

The eye sign due to hemispatial neglect / Sinal do olhar por negligência hemiespacial: um relato de caso

Abstract: Conjugate eye deviation is characterized by a sustained shift in horizontal gaze, usually toward the affected brain hemisphere. When detected on neuroimaging, it is called the ´eye sign`. It is classically associated with lesions involving the frontal eye s, ipsilateral to the side of the deviation. Neglect may be conceptualized as a spatially addressed bias of the sensory events in explicit behaviors and in the absence of perceptual and motor deficits. Hemispatial neglect is a common disabling condition that occurs following acute unilateral brain damage, usually to the right side. We report a case of a patient presenting with the ´eye sign` on tomography, following an acute subinsular stroke, in the absence of conjugated eyes deviation. Our hypothesis was that the sign may have been due to hemispatial neglect in this patient. The aim of this article was to discuss the mechanisms involved in the attention network and its neuroanatomic correlates.

Resumo: Desvio conjugado do olhar é caracterizado por um desvio sustentado horizontal da mirada, normalmente para o lado do hemisfério afetado. Quando visto por métodos de imagem, é chamado ´sinal do olhar`. O sinal é normalmente associado a lesões envolvendo o campo frontal do olho ipsilateral ao lado do desvio. Negligência pode ser conceitualizada como um viés espacial dos eventos sensoriais no comportamento explícito, na ausência de alterações da percepção e motoras. Negligência hemiespacial é uma condição comum e incapacitante que ocorre após lesão cerebral aguda, principalmente à direita. Nós relatamos um caso de um paciente que apresenta o ´sinal do olhar` na tomografia, após um infarto subinsular, na ausência de desvio conjugado do olhar. Nossa hipótese é que, neste paciente, o sinal pode ser devido à negligência hemiespacial. O objetivo deste artigo é discutir os mecanismos envolvidos na rede da atenção e seus correlatos anatômicos.

Neuroanatomy of Unilateral Neglect Syndrome

Unilateral spatial neglect is caused by a failure of attentional orienting mechanism. Over 90% of spatial neglect patients have right hemisphere injury. The most frequent sites of damage are right dorsal and ventral frontal cortex (Brodmann area 6, 8, 44), right inferior parietal and superior temporal cortex (Brodmann area 39, 40, 41) and subcortical nuclei (thalamus (pulvinar), putamen, caudate nucleus). Functional neuroimaging studies showed that spatial neglect is associated with lesions of dorsal fronto-parietal network which is involved in top-down control of selective attention, and right ventral fronto-parieto-temporal network which is specialized for detection of salient or unexpected stimuli. The ventral network works as a 'circuit breaker' for the dorsal system, directing attention to salient stimuli. Structural or functional disruption of both network cause unilateral spatial neglect.

Influence of Hemispatial Neglect on Trunk Control in Stroke Patients

OBJECTIVE: To evaluate the influence of hemispatial neglect on trunk balance control and functional ability in stroke patients. METHOD: Fourty eight inpatients exhibiting (n=25) or not exhibiting (n=23) hemispatial neglect following strokes within 6 months were matched for age and sex. Hemispatial neglect was assessed with a line bisection test (LBT) and a baking tray task test (BTT). Static and dynamic trunk balance control was assessed using a Balance Master System. Static balance control was measured with a weight bearing test and a Modified Clinical Sensory Interaction Balance Test (mCSIBT). Dynamic balance control was measured using a Limit of Stability (LOS) test and a rhythmic weight shift (RWS) test. A Functional Independence Measure (FIM) for functional ability and the Brunnstrom stage assessment for motor recovery were also recorded. RESULTS: There was no statistical difference in the achievement of static trunk balance control between neglect and non-neglect patients. Where dynamic balance control was concerned, both LOS and RWS tests showed a deterioration in neglect patients compared to non-neglect patients (P <0.05). The Brunnstrom stage correlated significantly with dynamic balance control only in non-neglect patients (p<0.05) and the FIM score of neglect patients was significantly lower than that of non-neglect patients (p<0.05). CONCLUSION: Stroke patients with hemispatial neglect displayed pronounced dynamic trunk instability and functional dependency compared to patients without it. However, the recovery of dynamic balance control may not relate to the degree of motor recovery in stroke patients with hemispatial neglect.

Screening tests are not enough to detect hemineglect

OBJECTIVE: To verify the sensitivity of the conventional subtests of the Behavioral Inattention Test (BIT) in the diagnosis of hemineglect after stroke. METHOD: One hundred and two patients with cerebral infarct or hemorrhage were prospectively evaluated. In 22, hemineglect was diagnosed using standard BIT criteria. The frequency of hemineglect using 6 commonly used screening subtests of this battery was assessed. RESULTS: Hemineglect would not be recognized in 10 patients if they were only screened using the line crossing test; this would be the case in 2 patients with the letter cancellation test; and in 4 patient with the line bisection test. Three patients would not be diagnosed even if both line crossing and line bisection tests were used. CONCLUSION: Hemineglect may not be recognized with single screening tests commonly used. The use of a standard battery is recommended to improve diagnostic sensitivity in individuals with various subtypes of hemineglect.

OBJETIVO: Verificar a sensibilidade dos subtestes convencionais da Behavioral Inattention Test (BIT) no diagnóstico da heminegligência após o acidente vascular cerebral (AVC). MÉTODO: Foram avaliados prospectivamente 102 pacientes com AVC. Em 22 casos heminegligência foi diagnosticada através do BIT. A freqüência de diagnóstico correto utilizando os 6 subtestes específicos desta bateria foi analisada. RESULTADOS: 10 pacientes não seriam diagnosticados como heminegligentes se fossem avaliados apenas com o " line crossing" , 2 se o teste de triagem escolhido fosse o " letter cancellation" , e 4 se utilizássemos apenas o " line bisection" . Além disso, 3 pacientes não teriam recebido o diagnóstico correto mesmo utilizando dois testes usuais de triagem - " line crossing" e " line bisection" . CONCLUSÃO: O uso de testes isolados de triagem pode falhar em diagnosticar heminegligência após o AVC. O uso de uma bateria formal de avaliação é necessário para identificar indivíduos com diferentes tipos de heminegligência.

Relationship between hemispatial neglect and homonymous hemianopia / 中国医师进修杂志

0.05). Conclusion HSN is a right cerebral hemisphere disease relating to cognitive impairment while homonymous hemianopia is the defect of visual field.