Signs and symptoms in spatial neglect syndrome: a systematic review and meta-analysis

Stroke is the second leading cause of mortality in the general population. Spatial neglect syndrome is one of the most common complications following stroke and is associated with poor prognosis, including prolonged hospitalization.

To examine the main clinical signs and symptoms associated with spatial neglect in stroke patients in the literature.

The present systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to assess the certainty of evidence, and the data were processed with RevMan Web (The Cochrane Collaboration).

A total of 362 articles were assessed, out of which 23 were included. A strong correlation was observed between clinical events and the presence of spatial neglect syndrome compared to control groups (oculomotor exploratory behavior [p < 0.00001; 95% CI 4.03-22.41], difficulty detecting stimuli on the left side (p < 0.0001; 95% CI 3.20-24.89), and prolonged reaction time to left-sided stimuli (p = 0.004; 95% CI 1.11-273.20). The present study confirms that spatial neglect syndrome presents as a clinically diverse condition. The quantitative analysis demonstrated that abnormal oculomotor behavior is the most robust and consistent clinical predictor for diagnosis. Other frequent symptoms included delayed reaction times and impaired detection of stimuli in the left visual field. Additionally, the presence of hemianopia and the crossed legs sign were also associated with spatial neglect syndrome among others.

The symptomatology described may serve as an indication of spatial neglect syndrome. Therefore, the present meta-analysis highlights the clinical importance of early identification and targeted evaluation in stroke cases.