Difference in recognition of right and left hemispheric stroke

Foerch, Christian; Misselwitz, B.; Sitzer, Matthias; Berger, Klaus; Steinmetz, Helmuth; Neumann‐Haefelin, Tobias

doi:10.1016/s0140-6736(05)67024-9

Cited by 159 publications

(147 citation statements)

References 7 publications

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“…These studies, therefore, did not help to distinguish between a true higher incidence of left-sided stroke because of a predilection of infarcts for the left side versus a difference in recognition of left-and right-sided strokes. [1][2][3] In our study, clinical ischemic strokes and TIAs were more frequently leftsided than right-sided. This was different from the distribution of infarcts on MRI.…”

Section: Discussionmentioning

confidence: 45%

“…[1][2][3] A predilection for the left side may be explained by characteristics of the atherosclerotic plaque in the left carotid artery or by anatomy. 3 The finding that isolated aphasia is a typical presentation of cardioembolic stroke or transient ischemic attack (TIA) also suggests that cardiac thrombi may preferably affect the left hemisphere.…”

mentioning

confidence: 99%

“…Leftsided strokes might be referred more frequently because they lead to clear symptoms, such as aphasia, whereas right-sided strokes may lead to less explicit symptoms, such as hemineglect or spatial disorientation. 1,5 Previous MRI studies also suggested that right-sided strokes are more often unnoticed because they found more right-sided silent infarcts in patients with carotid stenosis and atrial fibrillation. 6,7 An important advantage of MRI studies is that these not only detect clinical strokes but also clinically silent infarcts, thereby providing a better estimate of the true distribution of left-and right-sided infarcts.…”

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confidence: 99%

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Left-Sided Strokes Are More Often Recognized Than Right-Sided Strokes

Portegies

Selwaness

Hofman

et al. 2015

Stroke

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This study was embedded within the prospective population-based Rotterdam Study 8 and Rotterdam Scan Study. 9 From 1990 to 2012, we continuously followed up 13 894 participants (mean age, 65.5±10.3 Background and Purpose-Left-sided strokes are reported to be more common than right-sided strokes, but it is unknown whether they occur more often or are simply recognized more easily by clinicians. In a large unselected communitydwelling population, we examined the frequency of clinical left-and right-sided strokes and transient ischemic attacks (TIAs) and compared it with the frequency of left-and right-sided infarcts on MRI. Methods-This study was conducted within the population-based Rotterdam Study. Between 1990 and 2012, 13 894 participants were followed up for first-ever stroke and TIA. MRI scans were performed within a random subgroup of 5081 persons and were rated for the presence of supratentorial cortical and lacunar infarcts. We compared frequencies of left-and right-sided strokes, TIAs, or MRI infarcts using binomial and Fisher exact tests. Results-After a mean follow-up of 9.6 (±6.0) years, 1252 patients had a stroke, of which 704 were ischemic, and 799 participants had a TIA.

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Section: Discussionmentioning

confidence: 45%

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confidence: 99%

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confidence: 99%

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Left-Sided Strokes Are More Often Recognized Than Right-Sided Strokes

Portegies

Selwaness

Hofman

et al. 2015

Stroke

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“…However, these findings may not be conclusive as, although we were unable to show greater incidence of RSSI on the left, a higher‐powered study with the same variance might result in significance. In fact, few studies have reported left hemisphere strokes being more common (Foerch, Misselwitz, Sitzer, Berger, & Steinmetz, 2005; Hedna et al., 2013). A study found that the left cerebral vessels of patients with hypertension tended to be weaker and that there were differences in the intima–media thickness of the common carotid arteries, but was unable to prove if this was causally associated with stroke (Rodriguez Hernandez et al., 2003).…”

Section: Discussionmentioning

confidence: 99%

Interhemispheric characterization of small vessel disease imaging markers after subcortical infarct

et al. 2016

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BackgroundIn structural Magnetic Resonance Imaging (MRI) of patients with a recent small subcortical infarct (RSSI) and small vessel disease (SVD) imaging markers coexist. However, their spatial distribution and prevalence with respect to the hemisphere of the RSSI remain unknown.Materials and MethodsFrom brain MRI in 187 patients with an acute lacunar ischemic stroke clinical syndrome and a relevant diffusion weighted imaging (DWI)‐positive lesion, we semiautomatically extracted the RSSI, microbleeds, lacunes, old cortical infarcts, and white matter hyperintensities (WMH) using optimized thresholding in the relevant sequences, and rated the load of perivascular spaces. We registered all images to an age‐relevant brain template and calculated the probability distribution of all SVD markers mentioned for patients who had the RSSI in each hemisphere separately. We used the Wilcoxon and chi‐squared tests to compare the volumes and frequencies of occurrence, respectively, of the SVD markers between hemispheres throughout the sample.ResultsFifty‐two percent patients (n = 97) had the RSSI in the left hemisphere, 42% (n = 78) in the right, 2.7% (n = 5) in both, and 3.7% (n = 7) in the cerebellum or brainstem. There was no significant difference in RSSI frequency between left and right hemispheres (p = .10) in the sample. The median volume of the RSSI (expressed as a percentage of the total intracranial volume) was 0.05% (IQR = 0.06). There was no difference in median percent volume of the right RSSIs versus left (p = .16). Neither was there a significant interhemispheric difference in the volume of any of the SVD markers regardless of the location of the RSSI and they were equally distributed in both hemispheres.ConclusionAssessment of SVD imaging markers in the contralateral hemisphere could be used as a proxy for the SVD load in the whole brain to avoid contamination by the RSSI of the measurements, especially of WMH.

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“…The evidence base suggests that left hemisphere strokes tend to be slightly more common than those affecting the right hemisphere (see, for example, Foerch, Misselwitz, Berger, Steinmetz & Neumann-Haefelin, 2005), however a significant proportion (around 44%) of strokes result in damage to the right hemisphere. In their review of deficit patterns in right hemisphere stroke, Blake, Duffy, Myers & Tompkins.…”

Section: Right Hemisphere Communication Disorder (Rhcd) Is a Communicmentioning

confidence: 99%