Patients with visual neglect (VN) tend to start cancellation tasks from the right. This exceptional initial rightward bias is also seen in some right hemisphere (RH) stroke patients who do not meet the criteria of VN in conventional tests. The present study compared RH infarct patients’ (examined on average 4 days post-stroke) and healthy controls’ starting points (SPs) in three cancellation tasks of the Behavioural Inattention Test (BIT). Furthermore, task-specific guideline values were defined for a normal SP to differentiate the performance of healthy subjects from that of patients with subclinical inattention. Conventional tests indicated that 15 of the 70 RH infarct patients had VN. The control group comprised 44 healthy volunteers. In each task, the VN group started the cancellations mainly from the right. The non-neglect and healthy groups initiated most cancellations from the left, more so in the healthy group. Starting more than one BIT task outside the guideline value indicated pathological inattention, as this was typical among the VN patients, but exceptional among the healthy subjects. One-third of the non-neglect patients showed pathological inattention by starting more than one task outside the guideline value. Clinical assessment of VN should, therefore, include an evaluation of the SPs to detect this subtle form of neglect. (JINS, 2010, 16, 902–909.)

During the first year after RH infarct, originally left-sided manifestation of neglect shifted toward milder non-lateralized attentional deficit. Ipsilateral orienting bias and slowed processing speed appeared to be rather persistent neglect-related symptoms both in neglect patients and patients with initially milder inattention. We propose some effortless, tentative ways of examining processing speed and ipsilateral orienting bias alongside the BIT to better recognize these neglect-related symptoms, and highlight the need to assess and treat patients with initially milder inattention, who have been under-recognized and under-treated in clinical work. (JINS, 2018, 24, 617-628).

BackgroundThe aim of the study was to assess the association between thrombolysis and length of hospital stay after right hemisphere (RH) infarct, and to identify which cognitive functions were predictive of discharge.MethodsThe study group consisted of 75 acute RH patients. Thirty-three patients had thrombolysis. Neuropsychological examinations were performed within 11 days of stroke onset. The cognitive predictors were visual neglect, visual memory, visual search and reasoning and visuoconstructive abilities. The outcome variable was time from stroke to discharge to home.ResultsThrombolysis emerged as a statistically significant predictor of discharge time in patients with moderate/severe stroke (NIHSS ≥5). In the total series of patients and in patients with mild stroke (NIHSS <5), thrombolysis was not significantly associated with discharge time. Milder visuoconstructive defects shortened the hospital stay of the whole patient group and of patients with moderate/severe stroke. In all patient groups, independence in activities of daily living (ADL) was a significant single predictor of a shorter hospital stay. The best combination of predictors for discharge was independence in ADL in the total series of patients and in patients with mild stroke, and thrombolysis and independence in ADL in patients with moderate/severe stroke.ConclusionsThrombolytic treatment was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct, while cognitive functions had less predictive power.

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