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From the Cognitive Neurology Unit, Department of Medicine, Research Program in Aging, Sunnybrook Health Science Centre (SHSC), and the Institute of Medical Science, SHSC, University of Toronto (F.S. Leibovitch, S.E. Black, and P.L. Ebert); the Department of Medical Imaging, University of Toronto (Drs. Caldwell and Erlich); and Research Design and Biostatistics, SHSC, and the Clinical Epidemiology and Health Care Research Program, Department of Preventive Medicine and Biostatistics, University of Toronto (Dr. Szalai), Canada.
Address correspondence and reprint requests to Dr Black, Cognitive Neurology Unit A421, Sunnybrook Health Science Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5.
Objective: Structural and functional lesion localization in patients with hemispatial neglect.
Design: Location and severity of brain damage on CT and SPECT correlated with neglect performance as assessed with a battery of drawings, line bisection, and line and shape cancellation subtests.
Patients: Participants included 120 consecutive stroke patients with a single right-hemisphere-damaged lesion on CT who were admitted to the Acute Stroke Care Unit at Sunnybrook Health Science Centre. Of these, 88 also had a SPECT.
Results: On CT, 82 patients with neglect (compared with 38 without neglect) had more extensive damage in the parietal and sensorimotor cortex and white matter fiber bundles, including the posterior-superior longitudinal and inferior-frontal fasciculi (p < 0.05). Parietal and anterior cingulate damage best predicted neglect score using the CT data (p< 0.05), and regional blood flow in the parietal cortex best predicted neglect score using the SPECT data (p < 0.05) after controlling for the influence of age and lesion size on multiple linear regression.
Conclusions: Damage in the parietal and anterior cingulate cortex and posterior white matter fiber bundles correlated with hemispatial neglect. Combining structural- and functional-imaging techniques with neurobehavioral analysis can elucidate brain-behavior relationships.
Supported by grants from the Heart and Stroke Foundation of Ontario and the Ontario Mental Health Foundation.
Presented at the American Academy of Neurology Annual Conference in Boston, April 1997.
Received February 11, 1997. Accepted in final form November 6, 1997.
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