Impact of clinical severity of stroke on the severity and recovery of visuospatial neglect

PLoS One. 2018 Jul 2;13(7):e0198755. doi: 10.1371/journal.pone.0198755. eCollection 2018.


Background and purpose: There is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may also affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.

Methods: This is a secondary data analysis with merged data from two prospective cohort studies. Resulting in 90 patients and 8 longitudinal measurements at 1, 2, 3, 4, 5, 8, 12, and 26 weeks post-stroke onset. A letter cancellation test (LCT) was used as the primary outcome measure to demonstrate presence and severity of VSN. The clinical severity of stroke was classified using the Bamford Classification.

Results: No significant association between clinical severity and the number of ipsilesional, as well as contralesional, omissions on the LCT was observed. Recovery of VSN at the contralesional hemiplegic, as well as ipsilesional non-hemiplegic side, was only dependent on 'time' as a reflection of spontaneous neurobiological recovery post-stroke. The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group.

Conclusions: Larger strokes have a significant negative impact on recovery of visual attention at the non-hemiplegic side. No clinical determinants that regulate spontaneous time-dependent recovery of VSN were found. While early 'stroke severity' has been regarded as a strong predictor of functional outcome at a group level, other prognostic factors (demographic, stroke related) need to be determined.

Clinical trial registration: EXPLICIT-stroke Trial: Stroke Intensity Trial:

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attention / physiology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Perceptual Disorders / physiopathology*
  • Recovery of Function / physiology*
  • Severity of Illness Index
  • Space Perception / physiology
  • Stroke / physiopathology*
  • Stroke / therapy
  • Stroke Rehabilitation*
  • Visual Perception / physiology

Grant support

Supported by a grant from NWO (Netherlands Organization for Scientific Research; grant 451-10-013 to TCWN, and by the EXPLICIT-stroke grant of ZonMw (grant 89000001) and 4D-EEG (ERC advanced grant 291339-4D-EEG) to GK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.