Abstract

OBJECTIVE To determine whether stroke patients with diagonal neglect on cancellation may show diagonal neglect on line bisection, and hence to indicate whether diagonal neglect may be related solely to the type of test used or whether instead it may reflect a fundamental spatial disorder.

METHODS Nine patients with subacute right hemispheric stroke who neglected targets primarily in the near left direction on line cancellation bisected diagonal lines of two opposing orientations: near left to far right and far left to near right. The errors were assessed to determine whether line orientation significantly affected bisection error.

RESULTS Eight patients had significant bisection errors. One of these showed no effect of line orientation on error, consistent with lateral neglect. The remaining seven patients had a line orientation effect, indicating a net diagonal spatial bias. For the group, cancellation errors were significantly correlated with the line orientation effect on bisection errors.

CONCLUSIONS A significant diagonal bias on two tests of spatial attention may appear in stroke patients, although the directions of the biases may differ within individual patients. None the less, diagonal neglect may be a fundamental spatial attentional disturbance of right hemispheric stroke. Greater severity of stroke deficit as indicated by cancellation error score may be associated with a greater degree of diagonal neglect on line bisection.