MAJOR REVIEW
Visual Neglect Following Stroke: Current Concepts
and Future Focus
Darren S.J. Ting, MBChB,
1
Alex Pollock, PhD,
2
Gordon N. Dutton, MD, FRCOphth,
3,4,5
Fergus N. Doubal, MRCP,
6
Daniel S.W. Ting, MBBS,
7
Michelle Thompson, BSc (Hons),
6
and Baljean Dhillon, FRCPS, FRCS, FRCOphth
8
1
Victoria Infirmary, Glasgow, UK;
2
Nursing, Midwifery, and Allied Health Professionals (NMAHP) Research Unit,
Glasgow Caledonian University, Glasgow, UK;
3
Tennent Institute of Ophthalmology, Gartnavel General Hospital,
Glasgow, UK;
4
Royal Hospital for Sick Children, Glasgow, UK;
5
Department of Vision Sciences, Glasgow Caledonian
University, Glasgow, UK;
6
Western General Hospital, Edinburgh, UK;
7
Royal Perth Hospital, Western
Australia, Australia; and
8
Princess Alexandra Eye Pavilion, Edinburgh, UK
Abstract. Visual neglect is a common, yet frequently overlooked, neurological disorder following
stroke characterized by a deficit in attention and appreciation of stimuli on the contralesional side of
the body. It has a profound functional impact on affected individuals. A assessment and management
of this condition are hindered, however, by the lack of professional awareness and clinical guidelines.
Recent evidence suggests that the underlying deficit in visual attention is due to a disrupted
internalized representation of the outer world rather than a disorder of sensory inputs. Dysfunction of
the cortical domains and white-matter tracts, as well as inter-hemispheric imbalance, have been
implicated in the various manifestations of visual neglect. Optimal diagnosis requires careful history-
taking from the patient, family, and friends, in addition to clinical assessment with the line bisection
test, the star cancellation test, and the Catherine Bergego Scale. Early recognition and prompt
rehabilitation employing a multidisciplinary approach is desirable. Although no treatment has been
definitively shown to be of benefit, those with promise include prism adaptation, visual scanning
therapy, and virtual reality--based techniques. Further high quality research to seek optimum short-
and long-term rehabilitative strategies for visual neglect is required. (Surv Ophthalmol 56:114--134,
2011. Ó 2011 Elsevier Inc. All rights reserved.)
Key words. assessment
dorsal stream
neglect
rehabilitation
spatial representation
stroke
unilateral neglect
ventral stream
visual neglect
I. Introduction
Visual neglect (VN) is a neurological disorder
characterized by a deficit in attention to stimuli
on one side of the body, almost invariably contra-
lateral to the side of the cerebral lesion.
95
The
term has been used loosely and interchangeably
with hemispatial neglect, unilateral neglect, and
visual inattention. Its adverse impact on day-to-day
functioning and stroke rehabilitation outcome is
well established.
Stroke, whether ischemic or hemorrhagic, is a de-
bilitating and disabling condition that can impair
cognition, visuospatial, language, and motor func-
tion.
36
Motor rehabilitation following stroke is well
recognized, but rehabilitation for visual neglect,
a common and dramatic consequence of stroke,
105
114
Ó 2011 by Elsevier Inc.
All rights reserved.
0039-6257/$ - see front matter
doi:10.1016/j.survophthal.2010.08.001
SURVEY OF OPHTHALMOLOGY
VOLUME 56
NUMBER 2
MARCH–APRIL 2011