“Look straight ahead”—A new test to diagnose spatial neglect by computed tomography

Abstract

Spatial neglect is the dominant behavioral disorder after right hemisphere brain lesions. Reliabel diagnosis by formal neuropsychological testing is often achieved only later during hospitalization, leading to delays in targeted therapies. We propose a way to diagnose spatial neglect right at admission. We measured the conjugated eye deviation (CED) on the initial computed tomography (CT) scans, in combination with the verbal instruction “Please look straight ahead” during the scan. The command was implemented in the scanner program and automatically played before a cranial CT started. This prospective study included a total 46 consecutive subjects (16 patients with first ever right brain damage and no spatial neglect, 12 patients with first ever right brain damage and spatial neglect, and 18 healthy controls). The right brain damaged groups were submitted to paper pencil tests to access the diagnosis of a spatial neglect after radiological confirmation of the brain damage during the initial phase of their hospitalisation. This procedure allowed us to define a cut-off value of 14.1 degrees of CED to the ipsilesional side to differentiate right hemispheric stroke patients with versus without spatial neglect with a confidence interval of 99%. This simple addition to a radiological routine procedure provides a new tool to help diagnose spatial neglect at the earliest stage possible and thus offers the possibility of providing patients with optimized rehabilitative therapy from a very early stage on.

Structural disconnections caused by white matter hyperintensities in post-stroke spatial neglect

“…In this context, the present study addresses the most common and debilitating cognitive disorder after right hemisphere damage, namely spatial neglecta disorder of spatial attention and exploration. Patients with spatial neglect shift their attention towards their ipsilesional, right side of space while ignoring objects and people located on their contralesional, left side, with a persistent eye and head bias to the right (Coelho-Marques et al, 2023;Fruhmann-Berger & Karnath, 2005). Spatial attention and exploration is proposed to be processed within a perisylvian brain network Karnath, 2009;, which is supported by commonly damaged white matter pathways (Bartolomeo et al, 2007;Karnath et al, 2009;Thiebaut de Schotten et al, 2014) and stroke lesion-derived structural disconnections (Saxena et al, 2022;Vaessen et al, 2016;Wiesen et al, 2020).…”

Spatial neglect therapy with the augmented reality app 'Negami' for active exploration training; A randomized controlled trial

“…Such patients act as though the left side of space has vanished. The patient's eyes and head are sustainedly oriented to the side of the brain lesion, which is typically the right side [3][4][5] . The patient's visual and tactile exploration activity is shifted to the right side; information located on the left side is disregarded.…”