White matter lesional predictors of chronic visual neglect: a longitudinal study
Open accessAbstract
Chronic visual neglect prevents brain-damaged patients from returning to an independent and active life. Detecting predictors of persistent neglect as early as possible after the stroke is therefore crucial to plan the relevant interventions. Neglect signs do not only depend on focal brain lesions, but also on dysfunction of large-scale brain networks connected by white matter bundles. We explored the relationship between markers of axonal degeneration occurring after the stroke and visual neglect chronicity. A group of 45 patients with unilateral strokes in the right hemisphere underwent cognitive testing for neglect twice, first at the subacute phase (<3 months after onset) and then at the chronic phase (>1 year). For each patient, magnetic resonance imaging including diffusion sequences was performed at least 4 months after the stroke. After masking each patient's lesion, we used tract-based spatial statistics to obtain a voxel-wise statistical analysis of the fractional anisotropy data. Twenty-seven patients had signs of visual neglect at initial testing. Only 10 of these patients had recovered from neglect at follow-up. When compared with patients without neglect, the group including all subacute neglect patients had decreased fractional anisotropy in the second (II) and third (III) branches of the right superior longitudinal fasciculus, as well as in the splenium of the corpus callosum. The subgroup of chronic patients showed reduced fractional anisotropy in a portion the splenium, the forceps major, which provides interhemispheric communication between regions of the occipital lobe and of the superior parietal lobules. The severity of neglect correlated with fractional anisotropy values in superior longitudinal fasciculus II/III for subacute patients and in its caudal portion for chronic patients. Our results confirm a key role of fronto-parietal disconnection in the emergence and chronic persistence of neglect, and demonstrate an implication of caudal interhemispheric disconnection in chronic neglect. Splenial disconnection may prevent fronto-parietal networks in the left hemisphere from resolving the activity imbalance with their right hemisphere counterparts, thus leading to persistent neglect.
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Streams of conscious visual experience
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- Authors
- Lunven, M., Thiebaut De Schotten, M., Bourlon, C., Duret, C., Migliaccio, R., Rode, G., & Bartolomeo, P.
- Affiliations
- Lyon 1 Université (FR)
- Centre National de la Recherche Scientifique (FR)
- Università Cattolica del Sacro Cuore (IT)
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-01-19
- Volume
- 138
- Issue
- 3
- Pages
- 746-760
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC4339774
- OpenAlex
- W1973739205
- Cited by
- 222
- References
- 122
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 14 · 2023: 15 · 2022: 26 · 2021: 19 · 2020: 22 · 2019: 20 · 2018: 20 · 2017: 27 · 2016: 24 · 2015: 8 · 2012: 1
- FWCI
- 15.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Brain (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- Agence Nationale de la Recherche (ANR-13-JSV4-0001)
- National Institutes of Health (5u54mh091657-05)
- National Institute of Mental Health (1U54 MH091657)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Spatial Neglect and Hemispheric Dysfunction
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- stroke, white matter lesions, axonal degeneration, fractional anisotropy, superior longitudinal fasciculus, corpus callosum, splenium, forceps major, interhemispheric disconnection, right hemisphere stroke, tract-based spatial statistics
- MeSH terms
- Adult, Aged, Brain Mapping, Female, Humans, Image Processing, Computer-Assisted, Functional Laterality, Longitudinal Studies, Male, Middle Aged, Neuropsychological Tests, Perceptual Disorders, Predictive Value of Tests, Regression Analysis, Severity of Illness Index, Visual Perception, Anisotropy, Diffusion Tensor Imaging, Leukoencephalopathies
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