Visual Neglect after PICA Stroke—A Case Study

Abstract

After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS). However, it remains unclear whether visual neglect can also be part of CCAS. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellar–cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions.

Left Cerebellar Lesions may be Associated with an Increase in Spatial Neglect-like Symptoms

“…Although symptoms of spatial neglect following cerebellar damage have been observed in single-case studies (e.g., Geiser et al, 2022;Hildebrandt et al, 2002;Silveri et al, 2001), group studies in adults have provided contrasting results. Kim and colleagues (2008) found evidence of either ipsilateral or contralateral neglect in 8/28 patients using a composite neglect score comprised of performance across several different line bisection, cancellation, and figure copying tasks.…”

“…Although there have been single case reports of spatial neglect following focal cerebellar injury in adults (Geiser et al, 2022;Hildebrandt, Spang, & Ebke, 2002;Silveri, Misciagna, & Terrezza, 2001), there have only been a few group studies, and they have produced mixed results (Baier, Karnath, et al, 2010;Frank et al, 2010;Kim et al, 2008;Richter et al, 2007). Specifically, Kim and colleagues (Kim et al, 2008) observed neglect in 8/28 patients using a composite neglect score.…”

Parameters of Auditory Evoked Related Potentials P300 in Disorders of Different Cognitive Function Domains (Visuospatial/Executive and Memory) in Elderly Hypertensive Persons

“…The syndrome of visuospatial neglect is one of the phenomena of optic-spatial agnosia, which occurs when there is unilateral damage to the cortical structures of the posterior brain regions and when visual function is preserved, but the neural networks underlying this recovery are not well understood [24,25]. Further, temporarily occurring and transient visual neglect may be part of a cognitive-affective syndrome following cerebellar circulatory disturbances, which is very difficult to suspect either clinically or by paper-based testing [26].…”

Editorial: Advances in Understanding and Rehabilitating Unilateral Spatial Neglect

“…Finally, Nora Geiser and collaborators [4] discussed the role of the cerebellum in spatial processing. They presented a case study of visual neglect following a cerebellar stroke affecting the left PICA, which was detected only with more complex tasks and eye-tracking recording.…”