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Right spatial neglect after left hemisphere stroke

Qualitative and quantitative study

From the Centre de Rééducation (Dr. Beis, C. Keller and N. Morin), Lay St. Christophe, Institut Régional de Réadaptation, Nancy, France; Hôpital Raymond Poincaré (Dr. Azouvi, A. Louis-Dreyfus and C. Samuel), Garches, France; Service de Rééducation Neurologique (Drs. Bernati and Rousseaux), CHRU, Lille, France; INSERM EMI 007 (Dr. Bartolomeo), Centre Paul Broca, Paris, France; Laboratoire de Psychologie Experimentale (Dr. Chokron), CNRS UMR 5105, Grenoble, France; Centre Neurologique William Lennox (Dr. Leclercq), Ottignies-Louvain-la-Neuve, Belgium; Service de Rééducation (Drs. Marchal and Pradat-Diehl), Hôpital de la Salpétrière, Paris, France; Centre de Rééducation l’Espoir (Y. Martin), Lille-Hellemmes, France; Service de Rééducation Neurologique (Dr. Perennou), Centre Medical, Le Grau du Roi, France; CRN (Dr. Prairial), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Service de Rééducation Neurologique (Dr. Rode), Hôpital Henry Gabrielle, Lyon, France; Laboratoire de Psychologie Expérimentale (Dr. Sieroff), Université René Descartes, Paris, France; and Centre de la Tour de Gassies (Dr. Wiart), Bruges, France.

Address correspondence and reprint requests to Dr. Jean-Marie Beis, Centre de Rééducation, 4 rue du Professeur Montaut, 54690 Lay St. Christophe, Institut Régional de Réadaptation, Nancy, France; e-mail: jeanmarie.beis{at}wanadoo.fr

Objectives: Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke.

Methods: Seventy-eight left hemisphere stroke patients were assessed. The test battery included a preliminary assessment of anosognosia and visual extinction, a clinical assessment of gaze orientation and personal neglect, and paper-and-pencil tests of spatial neglect in the peripersonal space. Only nonverbal tests were used.

Results: Drawing and cancellation tasks revealed neglect in 10 to 13% of patients. The combined battery was more sensitive than any single test alone. A total of 43.5% of patients showed some degree of neglect on at least one measure. Anatomic analyses showed that neglect was more common and severe when the posterior association cortex was damaged.

Conclusions: The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.

Received March 4, 2004. Accepted in final form July 2, 2004.

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