Perceptual differences between stroke patients with cerebral infarction and intracerebral hemorrhage

Objective: To assess perceptual performances of patients with intracerebral hemorrhage (ICH) compared with those of ischemic patients early after stro ke and to analyze the psychometric properties of three perceptual tests use d in the study. Design: Cross-sectional study. Setting: A rehabilitation unit at a teaching hospital. Patients: Twenty-two stroke patients with ICH and 22 demographically matche d stroke patients with infarction. Main Outcome Measures: Loewenstein Occupational Therapy Cognitive Assessmen t (LOTCA), Rivermead Perceptual Assessment Battery (RPAB), and Motor-Free V isual Perception Test (MVPT). Results: Stroke patients with ICH had significantly more severe deficits on a task of thinking operations than did patients with infarction. A signifi cant lateralized effect of stroke existed in the ICH group, with patients w ith right-hemisphere strokes scoring lower than patients with left-hemisphe re strokes on the figure-ground discrimination subtest of the RPAB. A consi derable overlap among the three instruments was found. Yet, the observed co rrelations between supposedly similar subtests from the tests proved to be moderate, indicating that to a certain extent these test measures tap diffe rent perceptual processes. Four factors were generated from a joint LOTCA-R PAB-MVPT factor analysis. They assessed different facets of perceptual func tioning, including higher-level and lower-level perceptual skills, part/who le conceptual integration, and color perception. This factor pattern accoun ted for 75.5% of the variance. Conclusions: Higher-level perceptual functions tend to be relatively suscep tible to ICH stroke pathology early in the course of the disease. This info rmation has important clinical implications in the early treatment planning for the stroke patients with ICH, such that specific compensatory strategi es for these deficiencies should be devised to facilitate a successful reha bilitation. Knowledge regarding the influences of specific deficits on the performance of daily activities may also be useful to the patients' family.