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ARTICLES: 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 2008; 71: 1439-1444 [Abstract] [Full text] [PDF]

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Unilateral neglect is more severe and common in older patients with right hemispheric stroke

David N. Levine   (16 January 2009)

Reply from the authors

Rebecca F. Gottesman, Argye E. Hillis   (16 January 2009)

Unilateral neglect is more severe and common in older patients with right hemispheric stroke 16 January 2009
David N. Levine, Department of Neurology, New York University School of Medicine RIRM - 311, 400 East 34th Street, New York, NY 10016 Send Correspondence to journal: Re: Unilateral neglect is more severe and common in older patients with right hemispheric stroke david.levine{at}nyumc.org David N. Levine	Gottesman et al. demonstrate that advanced age and large lesion size increase the frequency and severity of acute left spatial neglect after right hemisphere infarction. [1] The authors offer several alternative hypotheses as to the means by which aging promotes neglect after stroke but do not offer a definitive answer. We performed a similar study, albeit on a smaller scale, where we examined the effects of lesion size, age, and the degree of pre-stroke cerebral atrophy on the severity of neglect in patients with right hemisphere infarction. [2] We found that both lesion size and degree of atrophy were important and independent predictors of the severity of neglect. The effects of age for a given lesion size could be explained by the degree of pre-stroke cerebral atrophy. The significant effect of cerebral atrophy, even in the largest strokes destroying much of the right hemisphere, indicate the importance of a healthy left hemisphere in acutely limiting the severity of left spatial neglect and in hastening its recovery after right hemisphere stroke. It would be interesting if Gottesman et al. could examine the uninvolved left hemispheres of their cases on MRI for degree of brain atrophy. This may be possible as the MRIs were performed within 24 hours of admission before the effects of stroke-induced edema in the right hemisphere would significantly distort the unaffected left side. References 1. Gottesman RF, Kleinman JT, Davis C, et al. Unilateral neglect is more severe and common in older patients with right hemisphere stroke. Neurology 2008;71:1439-1444. 2. Levine DN, Warach JD, Benowitz L, Calvanio R. Left spatial neglect: Effects of lesion size and premorbid brain atrophy on severity and recovery following right cerebral infarction. Neurology 1986;36:362-366. Disclosure: The author reports no disclosures.
Reply from the authors 16 January 2009
Rebecca F. Gottesman, Johns Hopkins University School of Medicine Meyer 6-109, 600 North Wolfe Street, Baltimore, MD 21287, Argye E. Hillis Send Correspondence to journal: Re: Reply from the authors rgottesm{at}jhmi.edu Rebecca F. Gottesman, et al.	We appreciate Dr. Levine’s interest in our manuscript [1] and we agree that pre-stroke brain atrophy is a likely mechanism by which age increases frequency and severity of neglect. We read Levine et al.'s article with interest and were intrigued by their finding that recovery from neglect was less complete among individuals with more atrophy. [2] In our study, atrophy was not excluded but we excluded individuals with dementia or known prior strokes. We do not have T1-weighted imaging available on all subjects, which would be the ideal sequence with which to measure atrophy. We agree that, in the future, this will be an important way to determine the role of brain atrophy on development of neglect after a stroke. Disclosure: The authors report no disclosures.