Sensitivity and Specificity of the Brentano Illusion Test in the Detection of Visual Hemi-Field Deficits in Patients with Unilateral Spatial Neglect

Abstract

Stroke survivors with right-brain damage (RBD) often present with attentional deficits such as left unilateral spatial neglect. Some patients also present with contralesional visual hemi-field deficits. A late detection of visual hemi-field deficits (VHFD) contributes to hampering neurorehabilitation and functional outcome of patients with neglect. The Brentano Illusion Test (BRIT) may be used for an early detection of VHFD during the neuropsychological assessment. In the present study, we determined the sensitivity and specificity of the BRIT for screening VHFD in patients with neglect. Sixty-four consecutive RBD patients were examined. Forty-five presented with neglect. Of these, 23 presented with VHFD (hemianopia or quadrantanopia) as detected by the Humphrey automated static visual field testing (reference standard). Consecutive patients also included 19 participants without neglect, who did not have any VHFD. The sensitivity and specificity of the BRIT for neglect patients were 78.3% (95% CI: 61.4–95.1) and 90.9 (95% CI: 78.9–100.0), respectively. Positive predictive value (PPV) was 89.6% (95% CI: 76.4–100.0); negative predictive value (NPV) 80.7% (95% CI: 65.2–96.2). No false positives in the group without neglect were identified. We conclude that the BRIT is an effective tool for clinical neuropsychologists to screen for possible VHFD in neglect patients during the neuropsychological assessment, allowing the refinement of the clinical picture in the neuropsychological report. An early detection of VHFD also allows referring the patient to standard diagnostics for a formal visual field examination, right from the first neuropsychological assessment.

FunctionaL Assessment Scale of Hemianopia (FLASH): A New Multidisciplinary Tool to Assess Hemianopia in Patients with Severe Acquired Brain Injury

“…The analysis of inter-rater reliability showed that different professionals' observations of the same subject were consistent, promoting interdisciplinary collaboration and a multidisciplinary approach to patient care. The sensitivity and specificity of the FLASH were reported as 81% and 77%, respectively, which aligns with previous studies on qualitative examinations such as the confrontation method of visual field tests [28,29]. The sensitivity and specificity values are known to depend on the type, density, and cause of the visual field defect, as well as the specific confrontation method employed.…”

Sensitivity and Specificity of Qualitative Visual Field Tests for Screening Visual Hemifield Deficits in Right-Brain-Damaged Stroke Patients

“…Seventy-three consecutive inpatients with acquired RBD (largely overlapping—75%—the sample described in [ 32 ]), referred for routine assessment following a stroke in the right-hemisphere, participated in the study. Inclusion criteria were as follows: age ≥ 18 years; a (haemorrhagic or ischaemic) lesion following a stroke in the right hemisphere (determined based on neuroimaging data).…”

“…The comprehensive list of tests can be found in the Supplementary Methods. The cut-offs used to classify participants into patients with neglect (N+) and without neglect (N−) can be found in [32]. As a result of the neglect battery, there were Three patients showed the presence of a deficit on this test.…”