An exploratory cohort study of sensory extinction in acute stroke: prevalence, risk factors, and time course

Abstract

Most studies on sensory extinction have focused on selected patients with subacute and chronic right hemisphere lesions. In studies conducted on acute stroke patients, risk factors and time course were not evaluated. Our aim was to determine the prevalence, risk factors, and time course of sensory extinction in the acute stroke setting. Consecutive patients with acute stroke were tested for tactile, visual, auditory, and auditory-tactile cross-modal extinction, as well as for peripersonal visuospatial neglect (PVN). Tests were repeated at 2, 7, 15, 30, and 90 days after initial examination. A multivariable logistic regression analysis was performed to test the association between sensory extinction and demographic and clinical risk factors. Seventy-three patients (38.4% women) were recruited: 64 with ischemic stroke and nine with haemorrhagic stroke. Mean age was 62.3 years (95% CI 58.8–65.7), mean NIHSS score was 1.6 (95% CI 1.2–2.1), and mean time to first examination was 4.1 days (95% CI 3.5–4.8). The overall prevalence of all subtypes of sensory extinction was 13.7% (95% CI 6.8–23.8). Tactile extinction was the most frequent subtype with a prevalence of 8.2% (95% CI 3.1–17.0). No extinction was found beyond 15 days after the first examination. After adjustment for age, sex, lesion side, type of stroke, time to first examination and stroke severity, a lesion volume ≥2 mL (adjusted OR = 38.88, p = 0.04), and presence of PVN (adjusted OR = 24.27, p = 0.04) were independent predictors of sensory extinction. The insula, the putamen, and the pallidum were the brain regions most frequently involved in patients with sensory extinction. Extinction is a rare and transient phenomenon in patients with minor stroke. The presence of PVN and lesion volume ≥2 mL are independent predictors of sensory extinction in acute stroke.Electronic supplementary materialThe online version of this article (doi:10.1007/s00702-016-1663-x) contains supplementary material, which is available to authorized users.

Phantom touch: How to unmask sensory unawareness after stroke

“…representations. In line with this interpretation, preliminary findings of patients' lesions analysis suggest a correlation between synchiric extinction and structures often damaged in classical tactile extinction (Chechlacz et al, 2013;de Haan, Karnath, & Driver, 2012;Kamtchum-Tatuene et al, 2017;Vallar, Rusconi, Bignamini, Geminiani, & Perani, 1994).…”

Frontier of Self and Impact Prediction

“…Subsequent studies confirmed that this visuo-tactile integration was not specific of PPS around the hand but could also be reported around other body parts, such as the face ( Làdavas et al, 1998b ; Farnè and Làdavas, 2002 ; Farnè et al, 2005a ). From a neuroanatomical point of view, studies have shown that brain lesions in frontal, temporal and parietal cortex in the right hemisphere are the most common regions leading to extinction ( Mattingley et al, 1997 ; Driver and Vuilleumier, 2001 ; Farnè et al, 2005b ; Vossel et al, 2011 ; Kamtchum-Tatuene et al, 2017 ), at locations considered as the human homologues of the monkey cortical regions involved in PPS processing and described above. In particular, this neurological disorder appears most often in patients with focal inferior parietal lesions.…”

Understanding Occupational Therapists’ Knowledge and Confidence When Assessing for Spatial Neglect: A Special Issue Review

“…For example, although 81% of occupational therapists said they were confident in identifying this form of SN, only 38% correctly identified all SN definitions in the knowledge check portion; instead, they selected definitions of other non–SN syndromes or impairments. This question was included because, although there is a body of literature stating that the two syndromes are different ( Kamtchum-Tatuene et al., 2017 ), there have also been discussions that extinction is a part of the SN syndrome ( Vuilleumier & Rafal, 2000 ). Kamtchum-Tatuene et al.…”

“…This question was included because, although there is a body of literature stating that the two syndromes are different ( Kamtchum-Tatuene et al., 2017 ), there have also been discussions that extinction is a part of the SN syndrome ( Vuilleumier & Rafal, 2000 ). Kamtchum-Tatuene et al. (2017) argued that extinction, as a unique syndrome, requires specific assessment and treatment methods.…”