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'Big picture' of brain changes may be crucial to recovery from stroke injury

A study of patients who have difficulty paying attention to the left side of their environment has provided some of the first direct evidence that brain injury can cause detrimental functional changes in brain regions far from the site of the actual injury.

"We normally don't consider changes in function beyond the site of brain injuries," says Maurizio Corbetta, M.D., the Norman J. Stupp Professor of Neurology at Washington University School of Medicine in St. Louis and lead author of the paper. "Our findings suggest that looking for functional changes beyond the injury site is critical to understanding the behavioral deficits caused by injury and assessing the options to accelerate recovery from those deficits."

The new study, published online Oct. 16 in Nature Neuroscience, focused on patients with injuries located on the right side of the brain, approximately between the temple and the ear, in areas known as the temporoparietal and ventral frontal cortex. In 25 to 30 percent of stroke patients, injuries in these regions lead to a condition known as spatial neglect.

"Soon after the injury, these patients may forget to shave the left side of their face, fail to eat food on the left side of a plate or seem to be unaware of their left arm," says Corbetta, who is clinical director of the Stroke and Brain Injury Program at the Rehabilitation Institute of St. Louis, where the patients were recruited. "But if you explicitly tell them to pay attention to the left side, then for a brief time they can. It's as if their brain can voluntarily overcome the impairment, but that rebalancing act is very temporary."

The condition, which annually afflicts an estimated 3 to 5 million patients worldwide, is typically most acute in the days and weeks immediately following a stroke but can become a chronic problem. Approximately 90 percent of all cases of spatial neglect are linked to right-brain injuries and lead to difficulty paying attention to the left side
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Contact: Michael C. Purdy
purdym@wustl.edu
314-286-0122
Washington University School of Medicine
17-Oct-2005


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