Spatial Neglect and Anosognosia After Right Brain Stroke

Abstract

Purpose of review: Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke.

Recent findings: Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available.

Summary: This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.

FIGURE 6-1. Photo of a patient with a right brain stroke and left spatial neglect who maintained an abnormal, asymmetric posture. His rightward head and eye turning (apparent rotation of his torso) caused severe neck and back pain.

Image courtesy of Victor W. Mark, MD. Reprinted with permission from Mark VW, Front Biosci. © 2003 The Author.

FIGURE 6-2. Photo of a man with spatial neglect after right brain stroke manifesting the hanging eyeglasses sign, which is evidence of asymmetric movement. The left temple of the eyeglasses rests on the side of the head, above the ear, because the leftward movement of the hand is too small to seat the eyeglasses on the ear on the left side.

Image courtesy of Victor W. Mark, MD. Reprinted with permission from Mark VW, Front Biosci. © 2003 The Author.

FIGURE 6-3. Evidence of prism adaptation treatment effects on daily living skills: reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and environmental navigation tests.

Sig. = significant; non-sig. = non-significant. Reprinted with permission from Champod AS, et al, Neuropsychol Rehabil. © 2016 Taylor & Francis Ltd.