More homogeneous patient samples and consistency in the assessment methods and evaluation times would facilitate comparisons of the occurrence and the impact of anosognosia on functional outcome. New methods need to be developed for the assessment of anosognosia. These new methods should take account of the subtypes of anosognosia both at verbal and at non-verbal levels.

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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.)

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.

In the acute phase of stroke, patients with left visual neglect (VN) automatically orient to the right hemispace. This study examined the presence of rightward bias after right hemisphere stroke within 10 days of stroke onset and after 6 months. Our sample comprised 43 patients and 49 healthy controls. Presence of VN was evaluated with the six conventional subtests of the Behavioral Inattention Test (BITC). Starting points were determined in three BITC cancellation tasks by measuring the distance between the starting point and the median line of the stimulus sheet in centimeters. Activities of daily living (ADL) were assessed with the Barthel Index. At baseline VN patients showed more robust rightward bias than patients without VN. The magnitude of rightward bias decreased clearly in the VN patients at follow-up. A favorable ADL outcome was observed in 90% of the patients with VN and in all of the patients without VN. The magnitude of rightward bias differed clearly between the patient groups and controls. Our result implies that VN was likely to have improved as measured by BITC sum scores, but symptoms of rightward attention bias were still detected. We therefore suggest that, for clinical purposes, it is important that attention bias is measured accurately after right hemisphere stroke.Keywords: Rightward bias; Recovery; Stroke; Visual neglect. INTRODUCTIONVisual neglect (VN) is a disabling disorder that frequently occurs after right hemisphere stroke (Bowen, McKenna, & Tallis, 1999;Ringman, Saver, Woolson, Clarke, & Adams, 2004), suggesting a special role for the right hemisphere in spatial attention (Halligan, Fink, Marshall, & Vallar, 2003; Heilman, Watson, & Valenstein, 2003;Shulman et al., 2010). Neglect refers to failure to report, respond, or orient to stimuli on the contralesional side of space that cannot be accounted for by primary sensory or motor deficits (Halligan, Cockburn, & Wilson, 1991; Heilman et al., 2003;Robertson & Halligan, 1999). One prominent theory of this asymmetry in VN is that the left hemisphere controls shifts of attention in the rightward direction, while the right hemisphere controls shifts of attention in either direction (Mesulam, 1981). In the acute phase of stroke, patients with left visual neglect (VN) automatically orient to the right hemispace. This study examined the presence of rightward bias after right hemisphere stroke within 10 days of stroke onset and after 6 months. Our sample comprised 43 patients and 49 healthy controls. Presence of VN was evaluated with the six conventional subtests of the Behavioral Inattention Test (BITC). Starting points were determined in three BITC cancellation tasks by measuring the distance between the starting point and the median line of the stimulus sheet in centimeters. Activities of daily living (ADL) were assessed with the Barthel Index. At baseline VN patients showed more robust rightward bias than patients without VN. The magnitude of rightward bias decreased clearly in the VN patients at follow-up. A favorable ADL outcome was...