Neural correlates of recovery from acute hemispatial neglect

Purpose: To investigate the neural correlates associated with recovery from acute spatial neglect resulting from right hemispheric stroke. Methods: Four neglect patients were investigated both behaviourally and by fMRI at an acute (18 +/- 5 days) and at a chronic stage (123 +/- 18 days) post stroke. Results: At the second assessment all patients showed substantial behavioural improvements. These were associated with an increase of neural activity in the right middle frontal gyrus, right inferior parietal cortex, right inferior temporal gyrus/fusiform gyrus, left superior temporal gyrus/angular gyrus and left anterior cingulate gyrus. Decreased neural activity at the second assessment was found in the right parahippocampal gyrus and left fusiform gyrus. Conclusions: The pattern of neural reorganisation comprises areas of a right hemisphere fronto-parietal attentional network and corresponding left hemisphere areas suggesting a compensatory recruitment of analogous contralesional areas. Interestingly, a more complex pattern of neural changes was observed in the fusiform gyri which have previously been implicated in lateralised directed spatial attention. There was an increase in the right hemisphere and a decrease in the left hemisphere. This pattern of recovery is reminiscent of a "push-pull" pattern previously described for the dorsal parietal cortex by Corbetta et al. (2005) in the recovery from spatial neglect.