The impact of lesion side on acute stroke treatment

Abstract

Patients with right-hemisphere strokes are 45% less likely to be treated with recombinant tissue plasminogen activator (rt-PA) compared to patients with left-hemisphere strokes. The presence of neglect confers a twofold increased likelihood of rt-PA administration. Prehospital delay and lack of standardized scores for the neglect syndrome may limit accessibility of patients with right-hemisphere stroke to thrombolysis.

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

“…Thus, by the selection of patients likely to respond to thrombolysis, we may have balanced baseline differences between RHS and LHS as to initial stroke lesion size resulting from the observed tendency of patients with RHS to present later to the emergency department. 5,6 Although in our sample both baseline imaging findings and outcome after thrombolysis were comparable between RHS and LHS, we may speculate that in previous studies differences in stroke outcome result from baseline differences in stroke lesion size which have not been studied. [7][8][9] We also demonstrated that initial DWI lesion volume are associated with clinical outcome after 90 days, which is consistent with previous findings of acute lesion volume being a strong predictor of clinical outcome.…”

“…16 As reported previously, we observed higher NIHSS scores in LHS with patients when compared with patients with RHS. Higher NIHSS scores in LHS have been observed frequently [5][6][7]17 and are likely to result from the composition of the NIHSS and the differences in quality and extent of the clinical symptoms between the 2 hemispheres. Aphasia as a symptom related to stroke lesions in the language-dominant (mainly left) hemisphere scores much higher in the NIHSS than corresponding symptoms of the nondominant (mainly right) hemisphere, such as spatial-constructive disorders, neglect, anosognosia, and agnosia.…”

“…Patients with right hemispheric stroke (RHS) were reported to present later to the emergency department than patients with LHS. [5][6][7] This has been interpreted as a result of the clinical characters of RHS, which frequently involves symptoms that are less clearly recognized by patients or relatives (eg, neglect, visual perception disorders) or come along with anosognosia. As a consequence, patients with RHS were also observed to have a lower chance of receiving treatment with intravenous tPA.…”

Stroke and the emergency medical services – enhancing performance within the chain of survival

“…A Canadian study found that patients with right-hemisphere stroke were almost 50% less likely to receive IVT than patients with left-hemisphere strokes. (Di Legge et al 2005) Moreover, posterior…”

Assessing anosognosia: a critical review

“…However, reviews of the literature have shown that chronic anosognosia is not as rare as textbooks suggest (see Table 1 in Cocchini et al, 2002;Orfei et al, 2007;Jehkonen et al, 2006), and several studies have pointed out how lack of awareness can seriously interfere with functional recovery and rehabilitation training (Gialanella & Mattioli, 1992;Maeshima et al, 1997;Hartman-Maeir et al, 2001;Hartman-Maeir et al, 2002;Appelros et al, 2002;Gialanella, et al, 2005;Di Legge et al, 2005).…”