Stroke Lesion Volumes and Outcome Are Not Different in Hemispheric Stroke Side Treated With Intravenous Thrombolysis Based on Magnetic Resonance Imaging Criteria

Abstract

We aimed at evaluating baseline clinical and imaging characteristics and outcome with regards to the affected hemisphere in patients with stroke treated with intravenous tPA based on magnetic resonance imaging (MRI) criteria, thus controlling for potential clinical and imaging confounders of possible siderelated differences in outcome, such as stroke lesion volume.Background and Purpose-Patients with right hemispheric stroke (RHS) have been reported to have fewer good outcomes after thrombolysis. We aimed at evaluating outcome after stroke thrombolysis with regards to the affected hemisphere controlling for stroke lesion volume as a potential confounder. Methods-We retrospectively analyzed data from a prospective study of patients with acute stroke treated with intravenous tissuetype plasminogen activator, based on magnetic resonance imaging criteria within 6 hours of symptom onset. Neurological deficit was assessed by the National Institutes of Health Stroke Scale. Lesion volume on acute perfusion imaging, diffusionweighted imaging (DWI) and perfusion imaging/DWI mismatch were measured. Clinical outcome was assessed after 90 days using the modified Rankin Scale, and relation to affected hemisphere was studied by multivariate analysis. Results-Of 173 patients, 55 (32%) presented with RHS, whereas 118 (68%) had left HS. Baseline National Institutes of Health Stroke Scale was lower in RHS (11.7 versus 13.6; P=0.031). There were no differences in DWI lesion volume (11.0 versus 17.8 mL; P=0.519), perfusion imaging lesion volume (98.9 versus 118.3 mL; P=0.395), perfusion imaging/ DWI mismatch (60 versus 85.05 mL; P=0.283). Clinical outcome was also comparable for both groups (modified Rankin Scale, 0-1; P=0.327). In multivariate analysis, DWI lesion volume (P<0.001) and age were associated with modified Rankin Scale at day 90, whereas affected hemisphere was not. Conclusions-We did not find differences between RHS and left HS with regards to stroke lesions volumes or outcome after thrombolysis. Previously reported hemisphere-related differences in stroke outcome may partly results from imbalances in stroke lesion volume between RHS and left HS.

Quality of life in patients with intracranial tumors: does tumor laterality matter?

“…Two studies on ischemic stroke report no difference in functional outcome based on stroke laterality. 6,7 Furthermore, a recent case series on patients after decompressive hemicraniectomy for ischemic stroke found no difference in health-related quality of life (HRQOL) between patients with left versus those with right hemisphere infarctions. 23 In a study of patients with brain tumors, tumor laterality could neither predict survival nor postoperative Karnofsky Performance Scale (KPS) score.…”

Hemicraniectomy for Dominant vs Nondominant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis

“…72 Additionally, a recent meta-analysis of seven trials on endovascular thrombectomy for large vessel occlusion found no difference in outcome between patients with right or left hemisphere stroke. 73 Neither has there been outcome disadvantage for patients with left hemisphere strokes after intravenous thrombolysis; 74 in fact, one study reported that they have better functional outcome. 75 Moreover, another study on MCA strokes discovered that injury to the right hemisphere leads to less favorable long-term outcome and increased mortality compared to left hemisphere strokes.…”

Relationship between normalized distributional pattern and functional outcome in patients with acute cardiogenic cerebral embolism

“…Lesion maps of the good and poor outcome groups differed in the present study. Stroke lesions in the right hemisphere, which is usually the non-dominant side, with corresponding symptoms of spatial-constructive disorders, neglect, anosognosia, and agnosia scores, resulted in a much lower National Institutes of Health Stroke Scale score than those in the left hemisphere as the language-dominant side; this difference in neurological severity has been associated with the outcome as predicted [18]. Ischemic locations in the good outcome group were concentrated in the right hemisphere, particularly the parietal and temporal lobes; this distribution map on normalized brain images from MRI indicated that the non-eloquent area correlates with good outcome in patients with cardioembolic stroke.…”

“…In addition, ischemic lesions with a substantial impact on the left hemisphere involve the speech area, suggesting that ischemic lesions related to motor and speech function contribute to patient outcome. On the other hand, several studies have reported the relationship between ischemic volume and outcome [18–21]. Yoo et al reported that a final infarct volume of approximately 50 mL after intra-arterial therapy using interventional devices offers a good threshold to distinguish good from poor outcome [20].…”