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From the Department of Neurology (Drs. Ringman and Saver), University of California, Los Angeles, CA; Department of Biometry and Epidemiology (Dr. Woolson), Medical University of South Carolina, Charleston, SC; and College of Public Health (Drs. Clarke and Adams), University of Iowa, Iowa City, IA.
Address correspondence and reprint requests to Dr. John M. Ringman, Department of Neurology, University of California, Los Angeles, 710 Westwood Plaza, Suite 2-238, Los Angeles, CA 90095-1769; e-mail: jringman{at}mednet.ucla.edu
Objective: To delineate the frequency, course, risk factors, and neuroanatomy of hemispatial neglect in a large stroke cohort.
Methods: One thousand two hundred eighty-one patients with acute stroke were enrolled in a multicenter trial of an anticoagulant. Presence and severity of neglect were assessed with the NIH Stroke Scale (NIHSS) neglect item, assessing tactile extinction and visuospatial neglect at entry, daily for 1 week, and at 3 months. Head CT scans were obtained on day 7, and infarct location and size were characterized.
Results: Neglect was common at presentation, occurring in 43% of right brain-lesioned (RBL) patients and 20% of left brain-lesioned (LBL) patients (p < 0.001). At 3 months, neglect was present in 17% of RBL patients and in 5% of LBL patients (p < 0.001). In RBL patients, neglect was most frequently associated with lesions involving the (in descending order) temporal, parietal, frontal, occipital lobes, basal ganglia, and thalamus. Neglect was more common and persistent with cortical than with subcortical lesions. Increasing age was associated with increased risk of neglect in RBL patients, whereas gender and handedness did not significantly affect neglect frequency.
Conclusions: This series confirms that hemispatial neglect may occur with damage to several supratentorial structures but is most common and persistent with lesions of the right temporoparietal cortex. Increasing age is associated with neglect, particularly after right brain lesions. Gender and handedness do not exert a marked effect on the likelihood of the occurrence of neglect.
Received August 14, 2003. Accepted in final form March 31, 2004.
Previously presented as a platform at the 2000 American Academy of Neurology Meeting.
This article has been cited by other articles:
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  R. F. Gottesman, J. T. Kleinman, C. Davis, J. Heidler-Gary, M. Newhart, V. Kannan, and A. E. Hillis Unilateral neglect is more severe and common in older patients with right hemispheric stroke Neurology, October 28, 2008; 71(18): 1439 - 1444. [Abstract] [Full Text] [PDF]
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 W. E. Huddleston and E. A. DeYoe The Representation of Spatial Attention in Human Parietal Cortex Dynamically Modulates with Performance Cereb Cortex, June 1, 2008; 18(6): 1272 - 1280. [Abstract] [Full Text] [PDF]
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 E. Becker and H.-O. Karnath Incidence of Visual Extinction After Left Versus Right Hemisphere Stroke Stroke, December 1, 2007; 38(12): 3172 - 3174. [Abstract] [Full Text] [PDF]
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 G. M. S. Nys, M. J. E. v. Zandvoort, H. B. v. d. Worp, L. J. Kappelle, and E. H. F. d. Haan Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke. Brain, August 1, 2006; 129(Pt 8): 2148 - 2157. [Abstract] [Full Text] [PDF]
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J. M. Ringman, J. L. Saver, R. F. Woolson, and H. P. Adams Hemispheric asymmetry of gaze deviation and relationship to neglect in acute stroke Neurology, November 22, 2005; 65(10): 1661 - 1662. [Abstract] [Full Text] [PDF]
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K. M. Heilman, Y. Jeong, and G. R. Finney Spatial cognition Neurology, December 14, 2004; 63(11): 1994 - 1996. [Full Text] [PDF]
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