Age and Ageing, Vol 28, 257-260, Copyright © 1999 by British Geriatrics Society
TP Cassidy, DW Bruce, S Lewis and CS Gray
BACKGROUND: Visuo-spatial neglect (VSN) after stroke is associated with a
poor prognosis for rehabilitation. The co-existence of a visual field
deficit (VFD) with VSN may be associated with impaired visuo-spatial
functioning and thereby poor functional outcome. OBJECTIVE: To determine
whether the presence of a VFD (i) exacerbates VSN and (ii) influences
recovery of VSN. METHODS: A prospective study of consecutive acute (<7
days), right-hemisphere stroke patients who were able to undergo detailed
assessment of visuo-spatial functioning and visual fields. Clinical
assessment and a standardized neuropsychological test was administered by
one observer, followed by independent assessment of visual fields by a
second observer. Patients were followed up for 12 weeks with 4-weekly
re-assessments. RESULTS: 44 consecutive patients (23 women) with a first in
a lifetime, acute hemisphere stroke were recruited. Twenty had VSN and VFD,
seven VSN only, one VFD only and 17 had normal visual fields and no
neglect. The finding of a VFD was significantly associated with the
presence of VSN (P<0.0001). Patients with both VFD and VSN had a
significantly lower score on the behavioural inattention test. One month
post-stroke, this difference was no longer significant. Recovery of VSN and
VFD was maximal in the first month, however VSN recovery continued for up
to 12 weeks. Patients with VSN and a VFD on admission had a greater
mortality at 1 and 3 months. CONCLUSION: The presence of a VFD does appear
to exacerbate neglect in the acute stroke patient; this effect is no longer
seen after 1 month. Recovery of VSN continues independent of a VFD.
Patients with neglect and a VFD have an increased mortality, probably
because of greater neurological impairment.
ARTICLES
The association of visual field deficits and visuo-spatial neglect in acute right-hemisphere stroke patients
Department of Medicine, Royal Infirmary, Edinburgh, UK.
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