Mid-range visual deficits after stroke: Prevalence and co-occurrence

Abstract

Visual deficits are common after stroke and are powerful predictors for the chronic functional outcome. However, while basic visual field and recognition deficits are relatively easy to assess with standardized methods, selective deficits in visual primitives, such as shape or motion, are harder to identify, as they often require a symmetrical bilateral posterior lesion in order to provoke full field deficits. Therefore, we do not know how often they occur. Nevertheless, they can have severe repercussions for daily-life functioning. We aimed to investigate the prevalence and co-occurrence of hemifield "mid-range" visual deficits (i.e. color, shape, location, orientation, correlated motion, contrast, texture and glossiness), using a novel experimental set-up with a gaze-contingent presentation of the stimuli. To this end, a prospective cohort of 220 ischemic (sub)cortical stroke patients and a healthy control group was assessed with this set-up. When comparing performance of patients with controls, the results showed that deficits in motion-perception were most prevalent (26%), followed by color (22%), texture (22%), location (21%), orientation (18%), contrast (14%), shape (14%) and glossiness (13%). 63% of the stroke patients showed one or more mid-range visual deficits. Overlap of deficits was small; they mostly occurred in isolation or co-occurred with only one or two other deficits. To conclude, it was found that deficits in "mid-range" visual functions were very prevalent. These deficits are likely to affect the chronic post-stroke condition. Since we found no strong patterns of co-occurrences, we suggest that an assessment of deficits at this level of visual processing requires screening the full range of visual functions.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Examples of stimulus-pictures used to assess the perception of A) color, B) shape, C) location, D) orientation, E) contrast, F) glossiness, G) texture and H) correlated motion.

Fig 2. Schematic overview of the task-paradigm for the assessment of shape-perception with the cumulative time in ms.

Fig 3. The mean scores for the patient group and the HC-group.

For motion perception, lower scores indicate better performance. For all other tasks, higher scores indicate better performance.

Fig 4. Frequencies of mid-range visual deficits after stroke, split for lesion lateralization.