Unilateral Spatial Neglect After Stroke: A Pragmatic Approach to Assessment and Rehabilitation

Unilateral spatial neglect (USN) is a neuropsychological syndrome characterized by a reduced awareness of, and attention toward, stimuli located in the contralesional space. The left side of the space is most frequently affected, due to the higher incidence of the disorder following right-hemisphere lesions, particularly within the territory of the right middle cerebral artery and, less commonly, the right anterior cerebral artery. Although USN can also occur following left-hemisphere damage, it is typically less severe and tends to resolve more quickly. USN is a common consequence of acquired brain injury, especially of vascular origin, and significantly impairs a patient's functional abilities and quality of life. Its high incidence in the acute phase after stroke, together with its potential persistence into the chronic stage, makes early diagnosis and timely rehabilitation essential. In this narrative review, we provide an overview of current assessment tools and rehabilitation approaches for post-stroke USN, with a focus also on recent advances and emerging therapeutic strategies. To illustrate diagnostic and therapeutic decision making, a representative case of a patient admitted to a Stroke Unit is reported, illustrating the application of assessment methods in a real-world setting. The aim of this review is to offer clinicians practical tools and evidence-based strategies to support a more effective and individualized management of patients affected by this complex and disabling condition.