Stroke: a third of patients with anterior circulation infarcts had visual neglect.

Clinical bottom line (level 2c)

  1. A third of patients with partial anterior circulation infarction will had visual neglect.
  2. Patients with partial anterior circulation infarction who had visual neglect showed no clear difference in mortality or discharge home, than those with no visual neglect.
Kalra et al: Stroke 1997; 28: 1386-1391
Expires December 2002

The study

Prospective cohort study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: stroke unit, UK

150 patients (aged mean 78 years, 62% female) Stroke with partial anterior circulation infarction determined according to clinical and radiological criteria, and a score of 3 to 5 on a validated scale (taking into account impairments in power, balance, proprioception and cognition) at 1 to 2 weeks after stroke.

Excluded if
  • TIA or reversible neurological deficit
  • hemianopsia or severe dysphasia
  • stroke extension resulting in greater deficits or assessments for visuospatial deficits that were considered inconclusive at review




    • followed for ?
    Outcomes studied:
  • visual neglect Identified by multidisciplinary assessments, including clinical tests such as visual and sensory confrontation tests, line bisection test and observation of patients during activities using a structured observational test for function.
  • mortality in no visual neglect group
  • mortality in visual neglect group
  • discharge home in no visual neglect group
  • discharge home in visual neglect group

    • Some patients with severe visual neglect may have been misdiagnosed as hemianopsia and excluded.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    visual neglect ? 47/146 32.2%
    (24.6% to 39.8%)
    mortality in no visual neglect group ? 2/99 2.02%
    (-0.75% to 4.79%)
    mortality in visual neglect group ? 3/47 6.39%
    (-0.61% to 13.4%)
    discharge home in no visual neglect group ? 65/99 65.7%
    (56.3% to 75.0%)
    discharge home in visual neglect group ? 28/47 59.6%
    (45.5% to 73.6%)

    Comments

    1. The median initial Barthel Index Score was significantly lower in patients with visual neglect despite comparable motor and cognitive scores.

    Citation

    1. Kalra L, Perez I, Gupta S, et al: The influence of visual neglect on stroke rehabilitation. Stroke 1997; 28: 1386-1391
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure visual neglect
    Comparison no visual neglect
    Outcome rehabilitation