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Visual neglect after left-hemispheric lesions: a voxel-based lesion–symptom mapping study in 121 acute stroke patients

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Abstract

Visual neglect after left-hemispheric lesion is thought to be less frequent, less severe, and shorter lived than visuospatial attention deficits resulting from right-hemispheric lesions. However, reports exist opposing this assumption, and it is unclear how these findings fit into the current theories of visuospatial processing. Furthermore, only little is known about the exact structure–function relationship between visuospatial attention deficits and left-hemispheric stroke. We investigated neglect in 121 patients with acute left-hemispheric ischemic stroke by following clinical development from within the first 24 h of stroke onset until hospital discharge. Visuospatial attention deficits occurred in 17.4 % (n = 21). Voxel-based lesion–symptom mapping associated visual neglect to the right with lesion in the left superior and middle temporal gyrus, temporal pole, frontal operculum, and insula. Neglect severity, captured by the Center of Cancellation Score of the Bells test, was associated with lesion in the left anterior temporal lobe and the left frontal operculum. The left-hemispheric lesion pattern of neglect thus involves areas of the ventral attention system and partly mirrors the critical regions of the right hemisphere known to be associated with neglect. Based on our prospective analysis on a large cohort of patients with left-hemispheric stroke, this study shows that in a remarkable number of patients, the left hemisphere essentially contributes to an intact representation of space and clarifies the impact of the distinct left-hemispheric structures involved in visuospatial processing.

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Acknowledgments

We thank G. Lind, S. Hoefer, S. Karn, and H. Mast for assistance in data acquisition and K. Astrahantseff for manuscript editing.

Funding

None of the authors has any financial or personal relationships with individuals or organizations that could inappropriately influence this submission. This work was supported by the Brain Links—Brain Tools Cluster of Excellence funded by the German Research Foundation (DFG, Grant #EXC1086).

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  1. Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany

    Lena-Alexandra Beume, Markus Martin, Christoph P. Kaller, Stefan Klöppel, Charlotte S. M. Schmidt, Michel Rijntjes, Cornelius Weiller & Roza M. Umarova

  2. Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany

    Lena-Alexandra Beume, Markus Martin, Christoph P. Kaller, Stefan Klöppel, Charlotte S. M. Schmidt, Horst Urbach, Karl Egger, Michel Rijntjes, Cornelius Weiller & Roza M. Umarova

  3. BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany

    Lena-Alexandra Beume, Markus Martin, Christoph P. Kaller, Stefan Klöppel, Charlotte S. M. Schmidt, Cornelius Weiller & Roza M. Umarova

  4. Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, 79106, Freiburg, Germany

    Stefan Klöppel

  5. Department of Neuroradiology, University Medical Centre Freiburg, 79106, Freiburg, Germany

    Horst Urbach & Karl Egger

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  1. Lena-Alexandra Beume
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Beume, LA., Martin, M., Kaller, C.P. et al. Visual neglect after left-hemispheric lesions: a voxel-based lesion–symptom mapping study in 121 acute stroke patients. Exp Brain Res 235, 83–95 (2017). https://doi.org/10.1007/s00221-016-4771-9

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