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Neurosci Biobehav Rev. 2017 Dec;83:1-10. doi: 10.1016/j.neubiorev.2017.09.024. Epub 2017 Sep 27.

Disruption of the ascending arousal system and cortical attention networks in post-stroke delirium and spatial neglect.

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Stroke Rehabilitation Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA. Electronic address:
Stroke Rehabilitation Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA; Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ, USA. Electronic address:


Delirium is an acute attention and cognitive dysfunction, adversely affecting functional outcomes and mortality. As many as half of hospitalized right brain stroke survivors may develop delirium. Further, about 50% of right stroke patients experience spatial neglect, impairing safety and recovery. In this review we explore the brain mechanisms, which may explain the high incidence of delirium and spatial neglect after right-brain stroke. We suggest that brain networks for spatial attention and arousal, composed of ascending projections from the midbrain nuclei and integrating dorsal and ventral cortical and limbic components, may underlie impairments in delirium and spatial neglect. We propose that lateralized deficits in spatial neglect may arise because cortical and limbic components of these functional networks are disproportionally impaired by right-brain strokes, and that spatial neglect may lower the threshold for developing delirium. An improved understanding of the brain basis of delirium and spatial neglect could provide a critical biomarker for initiating preventive care in stroke patients at high risk of hospital morbidity and loss of independence.


ARAS; Ascending arousal system; Ascending reticular activating system; Attention; Basal forebrain; Delirium; Dorsal attention network; Reticular formation; Spatial neglect; Stroke; Thalamus

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