Neglect Is More Common and Severe at Extreme Hemoglobin Levels in Right Hemispheric Stroke

Gottesman, Rebecca F.; Bahrainwala, Zainab; Wityk, Robert J.; Hillis, Argye E.

doi:10.1161/strokeaha.110.585265

Cited by 22 publications

(22 citation statements)

References 35 publications

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“…This finding extends previously reported work summarizing a physiologic basis based on concepts in viscosity and in retrospective studies, by adding infarct volume and severity of cerebral dysfunction into multivariable models as possible confounders. 12–19 It also further extends the suggestion that relative dehydration may be a contributing factor to dysfunction in ischemic stroke. 20 …”

Section: Discussionsupporting

confidence: 65%

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Dehydration Status is Associated With More Severe Hemispatial Neglect After Stroke

Bahouth

Bahrainwala

Hillis³

et al. 2016

The Neurologist

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Background Many stroke patients are clinically dehydrated at the time of hospital presentation, which could lead to an increase in blood viscosity and alteration in cerebral perfusion. Impaired cerebral perfusion can cause hemispheric dysfunction, which can be rapidly quantified with bedside tests of hemispatial neglect. We hypothesized that hospitalized patients with laboratory markers consistent with dehydration or a volume contracted state (VCS) would have more severe cerebral dysfunction defined by greater degree of neglect. Methods Subjects were a consecutive series of right-handed patients with acute right hemispheric stroke admitted within the Johns Hopkins Health System. All participants had clinical syndrome and MRI consistent with acute infarction. The primary definition of a VCS was a urea/creatinine ratio greater than 15; with secondary definition including urine specific gravity over 1.010. Acute infarct volume was measured on magnetic resonance imaging. Neglect was evaluated using a standardized battery of bedside tests. Results Of 201 patients meeting inclusion criteria, 131/201 (65%) had elevated BUN/creatinine ratios at admission. Approximately 61% (122/201) had some degree of neglect. Elevated BUN/Creatinine ratio was associated with an increased odds of severe neglect in unadjusted models (OR 4.1, 95% CI 1.2, 14.4), with loss of significance in adjusted models (OR 4.43, (95% CI 0.99, 19.8) after adjustment for age, infarct volume, sex, and NIHSS score. Conclusions Our data suggest that patients who are in a VCS at the time of stroke may have more frequent and severe neglect, with attenuation of results after adjustment for factors related to stroke size and age. If proven clinically relevant, a formalized rehydration strategy based on objective lab markers may represent an opportunity for improvement in outcome with low cost, broadly available treatment for acute stroke patients.

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Section: Discussionsupporting

confidence: 65%

“…As used in previous publications, any neglect was defined as a Z-score of at least 2 on any one of the three tests. 11,12 Severe neglect was defined as a Z-score of at least 2 on at least two of the three tests.…”

Section: Methodsmentioning

confidence: 99%

Dehydration Status is Associated With More Severe Hemispatial Neglect After Stroke

Bahouth

Bahrainwala

Hillis³

et al. 2016

The Neurologist

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“…Both low and high haemoglobin levels are associated with worse performance on tests of neglect and with more frequent neglect, independent of infarct size and stroke severity. 49 …”

Section: Individual-level Characteristicsmentioning

confidence: 99%

Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke

Gottesman¹,

Hillis

2010

The Lancet Neurology

266

198

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Stroke remains a primary cause of morbidity throughout the world mainly because of its effect on cognition. Individuals can recover from physical disability resulting from stroke, but might be unable to return to their previous occupations or independent life because of cognitive impairments. Cognitive dysfunction ranges from focal deficits, resulting directly from an area of infarction or from hypoperfusion in adjacent tissue, to more global cognitive dysfunction. Global dysfunction is likely to be related to other underlying subclinical cerebrovascular disease, such as white-matter disease or subclinical infarcts. Study of cognitive dysfunction after stroke is complicated by varying definitions and lack of measurement of cognition before stroke. Additionally, stroke can affect white-matter connectivity, so newer imaging techniques, such as diffusion-tensor imaging and magnetisation transfer imaging, that can be used to assess this subclinical injury are important tools in the assessment of cognitive dysfunction after stroke. As research is increasingly focused on the role of preventable risk factors in the development of dementia, the role of stroke in the development of cognitive impairment and dementia could be another target for prevention.

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“…In the first study where this association was found, a "U" pattern was suggested in the correlation between Hb and USN, where the critical levels, high or low, had determined worse USN 3 . Our results highlight the drop in Hb in the acute phase as a factor of severity and cognitive decline as measured by the USN tests.…”

Section: Discussionmentioning

confidence: 99%

“…Many people in acute phase of stroke present low haematocrit levels, which are associated with higher mortality and worsening long-term results; but the importance of low haemoglobin in stroke clinical presentation has not been clearly established 3,4,5,6,7 .…”

Section: Introductionmentioning

confidence: 99%

Low haemoglobin levels increase unilateral spatial neglect in acute phase of stroke

Luvizutto

Monteiro

Braga

et al. 2014

Arq. Neuro-Psiquiatr.

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Objective: The objective of this study was to evaluate the relationship between unilateral spatial neglect (USN) and haemoglobin (Hb) level in acute phase of stroke. Method: Cross-sectional study was performed after right hemisphere ischemic stroke. Independent variable: Hb level (mg/dL); Outcome: USN; Potential confounding factors: Age, National Institutes of Health Stroke Scale (NIHSS), and glycaemia (mg/dL); Characterization variables were obtained from electronic medical records, Hb, mean corpuscular volume (MCV) and glycaemia by laboratory exams, and USN by cancellation and bisection tasks. The relationship between Hb and USN was assessed by Spearman correlation and linear regression model. Results: 40 individuals were evaluated; it was observed that the higher the Hb level, the better the USN test performance, with the two being negatively correlated. There was no significant correlation between VCM level and USN performance. Conclusion: Low hemoglobin levels may indicate a worse performance in USN cancellation and bissection tests in acute phase of stroke.Keywords: stroke, perceptual disorders, haemoglobins. RESUMOObjetivo: O objetivo do estudo foi avaliar a relação entre a negligência espacial unilateral (NEU) e hemoglobina (Hb) na fase aguda do acidente vascular cerebral (AVC). Método: Foi realizado estudo transversal em pacientes com AVC de hemisfério direito dentro das primeiras 48 horas do ictus. Variáveis independentes: nível de Hb (mg/dL); Desfecho: NEU; Fatores potenciais de confundimento: Idade, National Institutes of Health Stroke Scale (NIHSS) e glicemia (mg/dL); A caracterização das variáveis foram obtidas por meio de prontuários eletrônicos, Hb e glicemia por exames laboratoriais, e NEU por meio do Line Cancellation (LCT), Star Cancelation (SCT), e Line Bisection Tasks (LBT). Resultados: 40 indivíduos foram avaliados e foi observado que quanto maior os níveis de Hb, melhor o desempenho nos testes de NEU, demonstrando correlação negativa entre eles. Conclusão: Níveis baixos de hemoglobina podem indicar pior desempenho nos testes de NEU na fase aguda do AVC.Palavras-chave: acidente vascular cerebral, transtornos da percepção, hemoglobinas.Low haemoglobin (Hb) is a common condition in the elderly population and is associated with increased mortality and worsening functional performance, independent of cause 1,2 . Many people in acute phase of stroke present low haematocrit levels, which are associated with higher mortality and worsening long-term results; but the importance of low haemoglobin in stroke clinical presentation has not been clearly established 3,4,5,6,7 .Currently, interest is growing in the effects of Hb concentration on cognitive decline. Critical Hb levels, high or low, have been associated with worsening cognitive performance in the elderly, but their mechanisms are poorly understood, with the hypothesis of the presence of ischemia, hypoxia or central nervous system oxidative stress 8,9 . Based on the results of several studies, there is speculation that reduced aerobic...

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Neglect Is More Common and Severe at Extreme Hemoglobin Levels in Right Hemispheric Stroke

Cited by 22 publications

References 35 publications

Dehydration Status is Associated With More Severe Hemispatial Neglect After Stroke

Dehydration Status is Associated With More Severe Hemispatial Neglect After Stroke

Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke

Low haemoglobin levels increase unilateral spatial neglect in acute phase of stroke

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