Unilateral spatial neglect in patients with cerebral hemorrhage: the relationship between hematoma volume and prognosis.

We examined patients with cerebral hemorrhage to determine the correlations between unilateral spatial neglect (USN) and neurological deficits, the site of lesions, and performance on activities of daily living (ADL) tests at discharge. Thirty-two right-handed patients with right hypertensive intracerebral hemorrhage (putamen 16, thalamus 16) were examined for neurological and neuropsychological deficits in addition to USN, and they received CT scans. USN was revealed in 26 of the patients (81.3%), of which 13 cases were putaminal hemorrhage and the other 13 were thalamic hemorrhage. The 32 patients were subdivided into three groups: those without USN, those with transient USN, and those with persistent USN. Among the patients with putaminal hemorrhage, the presence and persistence of USN seemed to be largely dependent on the size of the hematoma. Of the 7 cases with hematoma volume greater than 40ml, 4 revealed persistent USN; the other 3 cases, each of whom was under 50 years of age, showed transient USN. No cases with hematoma smaller than 20ml revealed USN. Among the thalamic hemorrhages, the size of the hematoma had no relation to the presence of USN. All 13 cases of USN caused by thalamic hemorrhage were transient. Among all the patients, those with USN showed lower ADL scores on admission than patients without USN. At discharge, ADL among patients with transient USN had improved more than the ADL of patients without USN. Therefore, we suspected that improvement in ADL might be affected by USN.