{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T13:55:23Z","timestamp":1781963723236,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,19]],"date-time":"2022-02-19T00:00:00Z","timestamp":1645228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["32003B_196915"],"award-info":[{"award-number":["32003B_196915"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["P2BEP3_195283"],"award-info":[{"award-number":["P2BEP3_195283"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["Z00P3_154714\/1"],"award-info":[{"award-number":["Z00P3_154714\/1"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS). However, it remains unclear whether visual neglect can also be part of CCAS. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellar\u2013cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions.<\/jats:p>","DOI":"10.3390\/brainsci12020290","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:14:46Z","timestamp":1645431286000},"page":"290","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Visual Neglect after PICA Stroke\u2014A Case Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9216-1666","authenticated-orcid":false,"given":"Nora","family":"Geiser","sequence":"first","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"},{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0766-8068","authenticated-orcid":false,"given":"Brigitte Charlotte","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"},{"name":"Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland"},{"name":"Institut du Cerveau\u2014Paris Brain Institute\u2014ICM, Inserm, CNRS, Sorbonne Universit\u00e9, 75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"R\u00fche","sequence":"additional","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noortje","family":"Maaijwee","sequence":"additional","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Nef","sequence":"additional","affiliation":[{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Cazzoli","sequence":"additional","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"},{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland"},{"name":"Department of Psychology, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-8935","authenticated-orcid":false,"given":"Thomas","family":"Nyffeler","sequence":"additional","affiliation":[{"name":"Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"},{"name":"ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland"},{"name":"Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s12311-019-01068-8","article-title":"The Cerebellar Cognitive Affective\/Schmahmann Syndrome: A Task Force Paper","volume":"19","author":"Argyropoulos","year":"2020","journal-title":"Cerebellum"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3672","DOI":"10.1093\/brain\/awr266","article-title":"The cerebellar cognitive profile","volume":"134","author":"Tedesco","year":"2011","journal-title":"Brain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s12311-019-01060-2","article-title":"The Cerebellar Cognitive Affective Syndrome\u2014A Meta-analysis","volume":"18","author":"Ahmadian","year":"2019","journal-title":"Cerebellum"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1176\/jnp.16.3.367","article-title":"Disorders of the cerebellum: Ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome","volume":"16","author":"Schmahmann","year":"2004","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.neulet.2018.07.005","article-title":"The cerebellum and cognition","volume":"688","author":"Schmahmann","year":"2019","journal-title":"Neurosci. Lett."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/brain\/121.4.561","article-title":"The cerebellar cognitive affective syndrome","volume":"121","author":"Schmahmann","year":"1998","journal-title":"Brain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1146\/annurev-neuro-070918-050258","article-title":"The Theory and Neuroscience of Cerebellar Cognition","volume":"42","author":"Schmahmann","year":"2019","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1076\/neur.8.3.323.16197","article-title":"Visuospatial hemi-inattention following cerebellar\/brain stem bleeding","volume":"8","author":"Hildebrandt","year":"2002","journal-title":"Neurocase"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1136\/jnnp.71.1.114","article-title":"Right side neglect in right cerebellar lesion","volume":"71","author":"Silveri","year":"2001","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1007\/s00415-010-5567-7","article-title":"Is there a link between spatial neglect and vestibular function at the cerebellar level?","volume":"257","author":"Baier","year":"2010","journal-title":"J. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s12311-010-0197-2","article-title":"Aphasia and neglect are uncommon in cerebellar disease: Negative findings in a prospective study in acute cerebellar stroke","volume":"9","author":"Frank","year":"2010","journal-title":"Cerebellum"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s00415-006-0500-9","article-title":"Cognitive functions in patients with MR-defined chronic focal cerebellar lesions","volume":"254","author":"Richter","year":"2007","journal-title":"J. Neurol."},{"key":"ref_13","first-page":"49","article-title":"The Bells Test: A quantitative and qualitative test for visual neglect","volume":"11","author":"Gauthier","year":"1989","journal-title":"Int. J. Clin. Neuropsychol."},{"key":"ref_14","unstructured":"Reinhart, S., Leonhard, E., and Kerkhoff, G. (2016). Sensitive Neglect Test (SNT) Single and Dual Task, Saarland University."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1212\/WNL.30.5.509","article-title":"Line bisection and unilateral visual neglect in patients with neurologic impairment","volume":"30","author":"Schenkenberg","year":"1980","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"839","DOI":"10.2466\/pms.1982.55.3.839","article-title":"Children\u2019s Production on Verbal and Non-Verbal Fluency Tasks","volume":"55","author":"Regard","year":"1982","journal-title":"Percept. Mot. Skills"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.cortex.2020.04.021","article-title":"Eyetracking during free visual exploration detects neglect more reliably than paper-pencil tests","volume":"129","author":"Kaufmann","year":"2020","journal-title":"Cortex"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1016\/j.neuropsychologia.2010.04.018","article-title":"A simple measure of neglect severity","volume":"48","author":"Rorden","year":"2010","journal-title":"Neuropsychologia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.neuropsychologia.2018.01.025","article-title":"The spatial distribution of perseverations in neglect patients during a nonverbal fluency task depends on the integrity of the right putamen","volume":"115","author":"Kaufmann","year":"2018","journal-title":"Neuropsychologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.neuropsychologia.2004.02.002","article-title":"Residual oculomotor and exploratory deficits in patients with recovered hemineglect","volume":"42","author":"Pflugshaupt","year":"2004","journal-title":"Neuropsychologia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"359","DOI":"10.3389\/fneur.2018.00359","article-title":"Eye-Tracking Provides a Sensitive Measure of Exploration Deficits After Acute Right MCA Stroke","volume":"9","author":"Delazer","year":"2018","journal-title":"Front. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.3389\/fnins.2019.01412","article-title":"Visual Exploration Area in Neglect: A New Analysis Method for Video-Oculography Data Based on Foveal Vision","volume":"13","author":"Kaufmann","year":"2020","journal-title":"Front. Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1111\/ejn.14309","article-title":"Re-fixation and perseveration patterns in neglect patients during free visual exploration","volume":"49","author":"Paladini","year":"2019","journal-title":"Eur. J. Neurosci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3478","DOI":"10.1016\/j.neuropsychologia.2012.09.043","article-title":"Unmasking the contribution of low-level features to the guidance of attention","volume":"50","author":"Onat","year":"2012","journal-title":"Neuropsychologia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"731","DOI":"10.3389\/fnins.2020.00731","article-title":"Test-Retest-Reliability of Video-Oculography During Free Visual Exploration in Right-Hemispheric Stroke Patients with Neglect","volume":"14","author":"Kaufmann","year":"2020","journal-title":"Front. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/S0028-3932(01)00224-X","article-title":"Investigation of the single case in neuropsychology: Confidence limits on the abnormality of test scores and test score differences","volume":"40","author":"Crawford","year":"2002","journal-title":"Neuropsychologia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1053\/apmr.2003.50062","article-title":"Behavioral assessment of unilateral neglect: Study of the psychometric properties of the Catherine Bergego Scale","volume":"84","author":"Azouvi","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.rehab.2015.12.005","article-title":"The ecological assessment of unilateral neglect","volume":"60","author":"Azouvi","year":"2017","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1093\/brain\/awq011","article-title":"Neuroimaging of eye position reveals spatial neglect","volume":"133","author":"Becker","year":"2010","journal-title":"Brain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1136\/jnnp.73.2.160","article-title":"Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke","volume":"73","author":"Azouvi","year":"2002","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.neuroimage.2012.03.020","article-title":"Age-specific CT and MRI templates for spatial normalization","volume":"61","author":"Rorden","year":"2012","journal-title":"Neuroimage"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.neuroimage.2007.10.002","article-title":"Enantiomorphic normalization of focally lesioned brains","volume":"39","author":"Nachev","year":"2008","journal-title":"Neuroimage"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.neuroimage.2009.01.045","article-title":"A probabilistic MR atlas of the human cerebellum","volume":"46","author":"Diedrichsen","year":"2009","journal-title":"Neuroimage"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3364","DOI":"10.1016\/j.cub.2018.08.059","article-title":"Topographic Cortico-cerebellar Networks Revealed by Visual Attention and Working Memory","volume":"28","author":"Brissenden","year":"2018","journal-title":"Curr. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jns.2008.08.012","article-title":"Hemispatial neglect in cerebellar stroke","volume":"275","author":"Kim","year":"2008","journal-title":"J. Neurol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.neuropsychologia.2004.02.015","article-title":"The Character-line Bisection Task: A new test for hemispatial neglect","volume":"42","author":"Lee","year":"2004","journal-title":"Neuropsychologia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1136\/jnnp.51.12.1481","article-title":"Visual hemispatial inattention: Stimulus parameters and exploratory strategies","volume":"51","author":"Weintraub","year":"1988","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1212\/WNL.23.6.658","article-title":"A simple test of visual neglect","volume":"23","author":"Albert","year":"1973","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/09602019108401377","article-title":"The behavioural assessment of visual neglect","volume":"1","author":"Halligan","year":"1991","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/BF00838444","article-title":"Visuo-spatial neglect: A new copying test to assess perceptual parsing","volume":"240","author":"Marshall","year":"1993","journal-title":"J. Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/0278-2626(85)90054-5","article-title":"Anterior-posterior interhemispheric differences in the loci of lesions producing visual hemineglect","volume":"4","author":"Ogden","year":"1985","journal-title":"Brain Cogn."},{"key":"ref_42","first-page":"386","article-title":"Consensus paper: Language and the cerebellum: An ongoing enigma","volume":"13","author":"Ackermann","year":"2014","journal-title":"Cerebellum"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1007\/s10072-019-03962-9","article-title":"\u201cAccent issue\u201d: Foreign accent syndrome following ischemic stroke","volume":"40","author":"Dono","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S0022-510X(96)00059-7","article-title":"Cerebellar induced aphasia: Case report of cerebellar induced prefrontal aphasic language phenomena supported by SPECT findings","volume":"144","author":"Saerens","year":"1996","journal-title":"J. Neurol. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2132","DOI":"10.1212\/01.WNL.0000146197.44568.CD","article-title":"Cerebellar lesions in the PICA but not SCA territory impair cognition","volume":"63","author":"Exner","year":"2004","journal-title":"Neurology"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/2\/290\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:23:08Z","timestamp":1760134988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/2\/290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,19]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["brainsci12020290"],"URL":"https:\/\/doi.org\/10.3390\/brainsci12020290","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,19]]}}}