Left side stroke
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Summary
8 papers analyzed
These studies suggest that left-sided strokes are more frequently recognized and may be more severe, but early cognitive rehabilitation and specific surgical techniques can improve outcomes.
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Understanding Left-Sided Strokes: Recognition, Severity, and Cognitive Impact
Higher Recognition of Left-Sided Strokes
Clinical Recognition and Frequency
Research indicates that left-sided strokes are more frequently recognized by clinicians compared to right-sided strokes. A study from the Rotterdam Study found that ischemic strokes and transient ischemic attacks (TIAs) were more often identified on the left side (57.7% and 57.8%, respectively) compared to the right side. However, MRI scans did not show a significant difference in the distribution of infarcts between the two hemispheres, suggesting that left-sided strokes are more easily recognized rather than more common.
Severity of Left-Sided Strokes
Stroke Severity and Vagal Nerve Activity
The severity of left-sided strokes tends to be higher than that of right-sided strokes. A study examining the role of vagal nerve activity found that patients with left-sided strokes had worse National Institutes of Health Stroke Scale (NIHSS) scores compared to those with right-sided strokes (10.6 vs. 7.6). Interestingly, this difference in severity was moderated by the patients' heart-rate variability (HRV). When HRV was low, the severity of left-sided strokes was significantly higher, but this difference was not observed when HRV was high.
Cognitive Dysfunction in Left-Sided Strokes
Cognitive Impairments
Cognitive dysfunctions are a common complication following a stroke, with left-sided strokes showing a higher prevalence of cognitive impairments. In a study assessing cognitive functions during the early rehabilitation period, 60.7% of patients with left-sided strokes exhibited predementia, compared to 22.2% of those with right-sided strokes. Patients with left-sided strokes also showed significant deficits in short-term memory, time knowledge, and orientation abilities.
Anosognosia and Self-Awareness
Anosognosia for Hemiparesis
Anosognosia for hemiparesis (AHP), a condition where patients are unaware of their motor deficits, is rare in left-sided stroke patients. In a study involving 44 acute left-sided stroke patients, only one patient exhibited AHP. This rarity suggests that the left hemisphere may not play a significant role in self-awareness of motor actions, contrary to some previous assumptions.
Implications for Treatment and Rehabilitation
Functional Outcomes and Treatment
The impact of stroke laterality on functional outcomes has been a subject of debate. A meta-analysis of endovascular thrombectomy trials found no significant difference in 90-day functional outcomes between left and right hemispheric strokes. This suggests that stroke side does not modify the treatment effect, emphasizing the importance of individualized treatment plans regardless of stroke laterality.
Cognitive Rehabilitation
Given the higher incidence of cognitive impairments in left-sided stroke patients, early cognitive rehabilitation is crucial. This approach should be tailored to address specific deficits such as memory, orientation, and executive functions to improve overall recovery outcomes.
Conclusion
Left-sided strokes are more frequently recognized and tend to be more severe compared to right-sided strokes. They are also associated with higher rates of cognitive dysfunctions, necessitating targeted rehabilitation strategies. Understanding these differences can help clinicians improve diagnosis, treatment, and rehabilitation outcomes for stroke patients.
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