The anatomy underlying acute versus chronic spatial neglect: a longitudinal study

Area of Science:

• Neuroscience
• Neurology
• Radiology

Background:

• Spatial neglect is a common and disabling consequence of stroke.
• Predicting the chronicity of spatial neglect is crucial for patient management and rehabilitation.
• Current understanding of lesion correlates for chronic spatial neglect remains incomplete.

Purpose of the Study:

• To investigate the predictive value of acute brain imaging for both acute/subacute and chronic spatial neglect.
• To conduct the first voxel-wise longitudinal lesion-behavior mapping study for spatial neglect.
• To identify specific brain structures associated with the persistence versus recovery of spatial neglect.

Main Methods:

• Longitudinal lesion-behavior mapping using voxel-wise analysis.
• Acute brain imaging (MRI) acquired early post-stroke (mean 6.2 days).
• Assessment of spatial neglect in the same individuals during acute/subacute (mean 12.4 days) and chronic (mean 491 days) phases.

Main Results:

• Approximately one-third of patients with acute spatial neglect also exhibited chronic neglect.
• Lesions in the superior and middle temporal gyri predicted both acute/subacute and chronic neglect.
• Subcortical involvement of basal ganglia and the inferior occipitofrontal fasciculus/extreme capsule were significant for persistent neglect. The uncinate fasciculus was critical for the emergence of chronic neglect.

Conclusions:

• Acute brain imaging can predict the trajectory of spatial neglect following stroke.
• Damage to specific cortical (temporal gyri) and subcortical (basal ganglia, white matter tracts) areas is associated with persistent spatial neglect.
• Absence of injury to these critical areas in patients with initial neglect suggests a favorable prognosis for recovery.