Introduction

Unilateral visual neglect is characterised by lateralised spatial–attentional deficits, resulting in dramatic behavioural impairments.1 Neglect negatively impacts functional outcome and needs to be successfully detected in order to inform neglect-specific as well as general post-stroke rehabilitation goals and strategies. It is therefore critically important to evaluate current clinical methods for detecting and measuring the extent of this syndrome.

Observational neurological assessments, such as the National Institutes of Health Stroke Scale (NIHSS), rely predominantly on subjective impression of impairment levels rather than objective measurements.2 Although the NIHSS was not designed as an individual diagnostic tool, it is frequently employed as one. However, previous research has suggested that observational assessments may not be sufficiently sensitive to visual neglect.2–4 The purpose of this study was to evaluate the diagnostic sensitivity of the NIHSS’ visual neglect item compared with a brief neuropsychological cancellation test and to identify factors which modulate this sensitivity.