Visual neglect as a predictor of functional outcome one year after stroke

Objectives - The aim was to study the role of visual neglect in acute right hemisphere brain infarct as a predictor of poor functional outcome during the first year after stroke. In particular, we were interested in the addit ional value of neglect measures besides hemiparesis, hemianopia, cognitive deficits and age. Patients and methods - A consecutive series of 57 patient s with a neuroradiologically verified right hemisphere infarct was examined within 10 days of the stroke. Fifty patients were followed up for 1 year. Neglect was measured with the Conventional and the Behavioural subtests of the Behavioural Inattention Test (BITC and BITE, respectively). The predict ors were determined at the 10-day examination. Functional outcome was asses sed 3, 6 and 12 months after the onset with the Frenchay Activities Index. Results - Neglect in BITE was the best single predictor, which together wit h high age formed the best combination of predictors for poor functional ou tcome at each follow-up. Hemiparesis was also included in this prediction m odel at the 3-month follow-up, but hemianopia, BITC, or visuoconstructional and memory deficits showed no additional predictive value. However, neglec t usually recovered soon. When neurological and cognitive deficits were ass essed at the same time as the outcome, hemiparesis rather than neglect was the strongest correlate of poor outcome. Conclusion - Neglect in acute stro ke is an important predictor of poor functional recovery. Residual neglect, which could be compensated in the follow-up tests, may nevertheless restri ct patients' real-life activities and hobbies.