Rightward bias in right hemisphere infarct patients with or without thrombolytic treatment and in healthy controls.

Right hemisphere (RH) infarct patients have a tendency to begin visual scanning from the right side of a given stimulus. Our aim was to find out whether RH patients with (T+) or without (T-) thrombolytic treatment and healthy controls differ in their starting points in three cancellation tasks. Our sample comprised of 77 patients and 62 controls. Thirty-four patients received thrombolysis. Rightward orientation bias was more evident in the T- group than in the T+ group. The T+ group showed a robust tendency to start all cancellation tasks more often on the right side than the controls. Regardless of whether they had visual neglect, patients in the T+ group showed still defective rightward orienting, possibly indicating residual attentional problems. The analyses of starting points in visual cancellation tasks provide additional information on residual symptoms of attention difficulties after stroke.

Predictors of functional outcome after right hemisphere stroke in patients with or without thrombolytic treatment.

The purpose of this study was to assess the predictors of functional outcome after right hemisphere stroke at 6-month follow up in patients with or without thrombolytic treatment. Thrombolysis did not predict functional outcome in instrumental activities of daily living (IADL). Lower acute phase basic activities of daily living (ADL) measured by the Barthel Index was a statistically significant predictor of IADL when adjusted for age and education (p = .015) and had borderline significance (p = .076) as a predictor of functional outcome when adjusted for severity of stroke at admission. When stroke severity was taken into account also higher age became a statistically significant (p = .039) predictor of functional outcome. The acute phase neuropsychological symptoms predicted the functional outcome in unadjusted analyses but when adjusted for age, education, and severity of stroke no independent association was found.

Thrombolytic therapy and visuoperceptual functions in right hemisphere infarct patients.

This study examines the association between thrombolysis and visuoperceptual functions in right hemisphere (RH) infarct patients. Fifty-six consecutive patients with first acute RH infarct were matched for age, years of education and stroke severity at the time of admission to the emergency department (baseline NIHSS; National Institute of Health Stroke Scale), compared according to whether (T+) or not (T-) they received thrombolysis. Neurological (NIHSS at hospital ward; Barthel index; BI) and neuropsychological examinations were conducted 4 days after onset. Visuoconstructive abilities were assessed with the block design and visual search and reasoning with the picture completion subtests of the Wechsler Adult Intelligence Scale revised. Visual neglect was assessed with the conventional subtests of the Behavioural Inattention test and visual memory with the visual reproduction subtest of the Wechsler Memory Scale Revised. T+ and T- patients did not differ in baseline NIHSS, age, years of education, hemianopia, hemiparesis, or in basic ADL (BI). T- patients had more severe strokes (NIHSS at hospital ward) and poorer visuoconstructive abilities than T+ patients. Our results indicate that thrombolysis has a favourable effect on visuoperceptual functions in acute stroke.

Is persistent visual neglect associated with poor survival?

BACKGROUND: The association of visual neglect with survival after right hemisphere (RH) stroke has received only limited attention. OBJECTIVE: This study explores the relationship of visual neglect and its spontaneous recovery to survival in a homogenous patient group with first-ever RH stroke. METHODS: Fifty-one RH stroke patients who suffered an infarct between 1994 and 1997 were retrospectively followed for survival until August 31, 2009. Acute-phase neurological, neuropsychological and neuroradiological data were studied to identify predictors of survival. RESULTS: Twenty-eight patients died during the follow-up. Age, education, and poor recovery of visual neglect emerged as significant single predictors of death. The best set of predictors for poor survival in the multivariate model was poor recovery of visual neglect and low education. CONCLUSIONS: Poor recovery of visual neglect is associated with long-term mortality in RH infarct patients. The follow-up of RH patients' neuropsychological performance gives additional information about the prognosis.

Predictors of discharge to home after thrombolytic treatment in right hemisphere infarct patients.

BACKGROUND: The aim of the study was to assess the association between thrombolysis and length of hospital stay after right hemisphere (RH) infarct, and to identify which cognitive functions were predictive of discharge. METHODS: The study group consisted of 75 acute RH patients. Thirty-three patients had thrombolysis. Neuropsychological examinations were performed within 11 days of stroke onset. The cognitive predictors were visual neglect, visual memory, visual search and reasoning and visuoconstructive abilities. The outcome variable was time from stroke to discharge to home. RESULTS: Thrombolysis emerged as a statistically significant predictor of discharge time in patients with moderate/severe stroke (NIHSS ≥5). In the total series of patients and in patients with mild stroke (NIHSS <5), thrombolysis was not significantly associated with discharge time. Milder visuoconstructive defects shortened the hospital stay of the whole patient group and of patients with moderate/severe stroke. In all patient groups, independence in activities of daily living (ADL) was a significant single predictor of a shorter hospital stay. The best combination of predictors for discharge was independence in ADL in the total series of patients and in patients with mild stroke, and thrombolysis and independence in ADL in patients with moderate/severe stroke. CONCLUSIONS: Thrombolytic treatment was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct, while cognitive functions had less predictive power.

Fluctuation in spontaneous recovery of left visual neglect: a 1-year follow-up.

Spontaneous recovery and possible fluctuation in left visual neglect, and its relation to stroke severity, basic activities of daily living (ADL) and extended ADL were examined at 10 days, at 3, 6, and 12 months after onset. Twenty-one of 56 right hemisphere stroke patients had visual neglect. Three visual neglect recovery groups were identified: continuous, fluctuating and poor recovery. We concentrated on the comparison of the continuous and the fluctuating recovery groups. At the acute phase the fluctuating recovery group had larger infarcts, more severe neglect and stroke, and a lower level of basic ADL compared to the continuous recovery group. In the continuous recovery group stable recovery was detected up to 6 months, whereas in the fluctuating recovery group recovery was incoherent in neglect and in extended ADL. A minimum follow-up period of 6 months including the evaluation of extended ADL is recommended for neglect patients due to possible fluctuation in visual neglect.

Impact of neglect on functional outcome after stroke: a review of methodological issues and recent research findings.

PURPOSE: This study provides an update on recent research findings concerning neglect and its impact on functional outcome. The review covers studies published during the past ten years. METHODS: A systematic review was carried out on reports drawn from electronic databases (MEDLINE and PSYCHLIT, January 1996 - August 2005) and identified from the lists of references in these reports. Unpublished reports, articles in other than the English language, and studies with non-human and non-adult subjects were excluded. The selection criteria were met by 26 articles. RESULTS: 15 of the 26 studies recruited heterogeneous patient groups (patients with right and left and/or unspecified lesions). The results from homogeneous groups (right hemisphere patients) were more consistent, emphasizing neglect as an independent predictor of functional outcome. Studies with homogeneous patient groups used consecutive series of patients, standardized measures of neglect, and a broader concept of functional outcome (both motor and cognitive items) than those with heterogeneous patient groups. Follow-ups longer than one year were very rare. CONCLUSIONS: Neglect has a significant negative impact on functional outcome, either as an independent predictive factor or in connection with other variables. The results, however, are inevitably affected by differences in patient samples and in the methods used in assessing neglect and functional outcome. Research focusing on homogeneous patient groups and especially on left hemisphere patients is needed. Neglect should be assessed with a standardized test battery rather than a single test, and functional outcome should be measured with scales consisting of cognitive, social and motor items. Also longer follow-ups are needed to verify the long-term functional outcome of neglect patients.

Anosognosia after stroke: assessment, occurrence, subtypes and impact on functional outcome reviewed.

PURPOSE: This review provides an update on recent research findings concerning the methods used in the assessment of anosognosia, the occurrence and subtypes of anosognosia, the association between anosognosia and neglect, and the impact of anosognosias on functional outcome. METHODS: A systematic review covering the period from 1995 to 2005 was carried out on reports drawn from electronic databases (MEDLINE, PSYCHLIT) and identified from the references in these reports. Twenty-seven articles met the selection criteria. RESULTS: The results of this review are in line with previous findings in the following respects: anosognosia was more often associated with right hemisphere damage, neglect and anosognosia co-occurred, and anosognosia had predictive value on poor functional outcome. The variation in the methods used in the assessment of anosognosia, patient samples and assessment times influence the occurrence rates and the predictive value of anosognosia, which might undermine the generalizability of the results. CONCLUSIONS: More homogeneous patient samples and consistency in the assessment methods and evaluation times would facilitate comparisons of the occurrence and the impact of anosognosia on functional outcome. New methods need to be developed for the assessment of anosognosia. These new methods should take account of the subtypes of anosognosia both at verbal and at non-verbal levels.