Screening for perceptual problems in acute stroke patients

Abstract

Simple screening tests for visual and tactile inattention were used to assess the frequency, associated features and rate of resolution of gross perceptual impairment in a group of 362 conscious patients, assessed within 48 hours of a cerebral hemisphere stroke. Two-thirds of the patients initially showed impairment on at least one of the tests, but by the end of the first week only half of the survivors still showed a deficit, and after a month this proportion had fallen below 30%. In 84 patients the results of the screening tests were compared with those of a more detailed assessment, the Rivermead Perceptual Assessment Battery (RPAB), performed one month after the stroke. The RPAB scores were strongly associated with the results of both screening tests, and particularly with those of the test for visual inattention/hemianopia. The results of the screening tests on admission to hospital predicted which patients would and would not develop significant perceptual problems later on. Thus, less than 10% of those with normal visual fields on day one achieved low scores on more than half the RPAB tests. All three indicators of perceptual impairment were associated with markedly worse outcome at six months, the RPAB scores having the greatest and visual fields the least prognostic value.