PICA INFARCT FREE

Each of the images was presented for 7 s and preceded by a central, black fixation-cross on a gray background (presented for 3 s), in order to enforce a common central starting point of visual exploration for all participants. In brief, 12 naturalistic images (i.e., color photographs of everyday scenes size 1200 Г— 900 pixels) and their mirrored versions (mirrored along the vertical axis) were shown on a computer screen.

PICA INFARCT FREE

In all three tests, the starting point was assessed (i.e., early orientation towards the left or the right ).ДЄdditionally, video-oculography during a free visual exploration paradigm (FVE) was performed in order to measure the spatial deployment of visual attention, as reflected by the horizontal distribution of visual fixations and early attentional orientation, i.e., the direction of the first saccade. The following previously established cut-off values were used to define the presence of a neglect: Bells Test (CoC > 0.081 ), SNT (single version CoC > 0.081, dual version CoC > 0.118 ), Line Bisection Test (mean relative rightward deviation of >11% ) and Five-Point Test (CoC > 0.081, spatial distribution of graphic production ). In case of an unbiased spatial distribution, the CoC value is 0, whereas positive CoC values indicate a rightward shift of space while negative CoC values indicate a leftward shift of space. The CoC is a measure used to define the centre of mass of the spatial distribution of detected items. To evaluate if a patient scored within a normal range, the Center of Cancellation (CoC) was calculated for both the cancellation and the Five-Point Test. In the Five-Point Test, patients actively generate designs instead of cancelling targets-this assessment is therefore known to be more demanding and shows a higher sensitivity compared to cancelling tests and the Line Bisection Test. In addition to the above-mentioned neglect-specific assessments, the Five-Point Test was conducted. Twenty-four days after stroke, several conventional, neglect-specific paper-pencil tests such as the Bells Test, the Sensitive Neglect Test (SNT) and the Line Bisection Test were performed as part of the clinical routine in our inpatient neurorehabilitation unit. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellarвЂ“cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. However, it remains unclear whether visual neglect can also be part of CCAS. After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS).

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