Rightward orienting bias, wheelchair maneuvering, and fall risk.

OBJECTIVE: To investigate whether rightward orienting bias, without neglect of left hemispace, increased accident risk. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of department of government medical center. PATIENTS: Successive right-cerebrovascular accident (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inpatient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and omissions in left hemispace on the Rey-Osterreith Complex Figure Drawing and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omissions), and 12 patients were placed in the Non-Neglect Stroke group (no evidence of unilateral neglect). Twenty male inpatients with no history of brain damage served as controls (Normal Control). MAIN OUTCOME MEASURES: Frequency of hospital falls and wheelchair obstacle course contacts. RESULTS: Both the L-OMIT and the R-BIAS groups had more inpatient falls than the other groups F(3,71) = 6.11, p < .001. On the wheelchair obstacle course, the L-OMIT group made more left-sided wheelchair collisions than any other group. However, the R-BIAS group also made more errors than the Non-Neglect Stroke and the Normal Control groups, F(3,55) = 5.72, p < .01). CONCLUSIONS: Results suggest that rightward orienting bias has clinical significance, even without more serious symptoms of unilateral neglect.

A scoring method for logical memory that is sensitive to right-hemispheric dysfunction.

We developed a relationally processing-based scoring system (RPSS) for the Wechsler Memory Scale's (WMS) Logical Memory subtest. Information from the stories was classified as either essential to the plot (Essential proposition) or nonessential to the plot (Detail proposition). The subjects' responses were also scored for intrusion errors (Self-Generated propositions). The normal control group's performance was compared with the performance of a right cerebrovascular accident group (R-CVA), and a left cerebrovascular accident group (L-CVA), each consisting of 20 right-handed subjects. ANOVAs revealed that the R-CVA group recalled significantly fewer Detail propositions and produced significantly more Self-Generated propositions than did the Normal Control group. In contrast, these groups recalled approximately the same number of Essential propositions. The L-CVA group recalled fewer Essential propositions than did any other group, but also produced the fewest intrusion errors.

Use of antiepileptic drugs in pregnancy.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in neurology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in neurology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Neurology of California Medical Association, and the summaries were prepared under its direction.

Prolonged spontaneous complex visual hallucinations and illusions as ictal phenomena.

A patient without a previous history of seizures had a generalized tonic-clonic seizure followed by multiple complex visual hallucinations and illusions (CVHIs) lasting weeks. The patient reported a total of 19 different CVHIs. EEGs performed revealed rhythmic right temporal activity occurring only during the CVHIs. Treatment with antiepileptic drugs (AEDs) resolved the CVHIs and normalized the EEG. An attempt at discontinuation of one AED resulted in a resurgence of the CVHIs and EEG abnormality.