White matter lesions and cognitive impairment may be related to recovery from unilateral spatial neglect after stroke

Abstract Background Unilateral spatial neglect (USN) is frequently found in ischemic stroke patients. Because USN is related to poor functional outcomes, evaluating recovery from USN after stroke is critical. Methods Patients with acute ischemic stroke with lesions in the right cerebral hemisphere on MRI and exhibiting left USN were administered the Behavior Inattention Test (BIT) at 1 and 3 weeks after admission. BIT improvement was defined as a ≥ 1-point increase in ≥ 4 of the 6 BIT subtests from 1 to 3 weeks, or a total BIT score ≥ 131 at 3 weeks. Factors associated with improvement of left USN were analyzed. Results Eighteen patients (8 men; mean age, 70 ± 12 years) were enrolled in this study. BIT was performed at 5.3 ± 0.7 and 18.2 ± 0.7 days after admission. Twelve patients were classified to the improvement (I) group, and 6 to the non-improvement (NI) group. BIT scores increased substantially from 76.6 ± 40.5 in the acute phase to 109.2 ± 43.3 in the subacute phase. The I group displayed higher BIT scores than the NI group in both acute and subacute phases ( P < 0.01 each). The degree of white matter lesions on the Fazekas scale was lower in the I group (0.6 ± 0.7) than in the NI group (1.7 ± 1.2, P = 0.028). Increased BIT scores correlated significantly with increased Mini Mental State Examination scores (r = 0.487, P = 0.040). Conclusions Amelioration of left USN might be related to white matter lesions and cognitive impairment. Sample size in the current study was small, limiting the generalizability of results, and larger studies are warranted in the future.