Left sided ischemic stroke
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Understanding Left-Sided Ischemic Stroke: Recognition, Cognitive Impairments, and Clinical Outcomes
Higher Recognition of Left-Sided Ischemic Strokes
Clinical Recognition and Frequency
Research indicates that left-sided ischemic strokes are more frequently recognized compared to right-sided strokes. A study within the Rotterdam population found that clinical ischemic strokes and transient ischemic attacks (TIAs) were more often left-sided (57.7% and 57.8%, respectively) compared to right-sided 1. This discrepancy in recognition is not mirrored in MRI findings, suggesting that left-sided strokes are more easily identified by clinicians, potentially due to more pronounced symptoms 1.
Cognitive Impairments in Left-Sided Ischemic Stroke
Severity of Cognitive Dysfunction
Patients with left-sided ischemic strokes exhibit more severe cognitive impairments than those with right-sided strokes. In a study assessing cognitive functions during early rehabilitation, 60.7% of patients with left-sided strokes showed significant cognitive impairments, compared to 22.2% of those with right-sided strokes 2. These impairments include decreased short-term memory, time knowledge, and orientation abilities, as well as poorer performance in visual, auditory, and verbal memory tests 2.
Asymmetry in Infarct Lesions and Symptom Severity
Distribution of Infarct Lesions
Voxel-based analysis of acute ischemic stroke patients revealed that infarcts in the left insular ribbon and lentiform nucleus are more common and associated with more severe symptoms at admission compared to their right-sided counterparts 3. This asymmetry suggests that left-sided strokes may present with more severe initial symptoms, influencing clinical outcomes 3.
Clinical Outcomes and Hospital Admission
Stroke Severity and Hospital Admission
Patients with left-sided strokes tend to have worse initial stroke severity scores and are more likely to seek medical attention sooner than those with right-sided strokes. A study found that patients with left-sided small-vessel occlusion visited hospitals within 6 hours of symptom onset more frequently than those with right-sided occlusions 4. This may be due to the more noticeable deficits in language and motor functions associated with left-sided strokes 4.
Vagal Nerve Activity and Stroke Severity
The severity of left-sided strokes can be moderated by vagal nerve activity. Patients with low heart-rate variability (HRV) exhibited significantly worse stroke severity scores for left-sided strokes compared to right-sided ones. However, this difference was not observed in patients with high HRV, suggesting that adequate vagal nerve activity may mitigate the severity of left-sided strokes 5.
Intracerebral Hemorrhage and Stroke Side
Risk of Intracerebral Hemorrhage (ICH)
The side of an ischemic stroke does not significantly influence the likelihood of developing intracerebral hemorrhage (ICH) after receiving IV-tPA treatment. A study found no significant difference in ICH rates between left-sided and right-sided ischemic stroke patients after controlling for age, stroke severity, and time to treatment 6.
Mortality and Functional Outcomes
Impact of Insular Involvement
Involvement of the right insular cortex in ischemic strokes is associated with higher mortality and worse functional outcomes compared to left insular involvement. This effect is particularly pronounced in mild to moderate strokes, where right insular involvement leads to significantly worse outcomes 7. This highlights the importance of considering stroke location in prognosis and treatment planning.
Conclusion
Left-sided ischemic strokes are more frequently recognized and associated with more severe cognitive impairments and initial symptoms compared to right-sided strokes. These differences in recognition and severity underscore the need for heightened clinical awareness and tailored rehabilitation strategies for patients with left-sided strokes. Understanding these nuances can improve patient outcomes and guide more effective stroke management.
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Most relevant research papers on this topic
Left-Sided Strokes Are More Often Recognized Than Right-Sided Strokes: The Rotterdam Study
Left-sided strokes and TIAs are more frequently recognized than right-sided strokes, suggesting more attention should be paid to right-sided symptoms.
Observational Study
Rigorous JournalCHARACTERISTICS OF COGNITIVE DYSFUNCTIONS IN PATIENTS WITH RIGHT-SIDE AND LEFT-SIDE ISCHEMIC STROKE
Early cognitive rehabilitation is crucial for all patients with hemispheric stroke, especially those with left-side brain damage.
Interhemispheric Asymmetry in Distribution of Infarct Lesions among Acute Ischemic Stroke Patients Presenting to Hospital.
Acute ischemic infarcts of the left insular ribbon and lentiform nucleus are more common in left-sided stroke patients, likely due to more severe symptoms at presentation.
Observational StudyDifferent variables between patients with left and right hemispheric ischemic stroke.
Patients with left-sided small-vessel occlusion visit the hospital earlier, while those with right-sided small-vessel occlusion may take longer to recognize neurologic deficits due to nondominant language or hand function.
Observational StudyVagal Nerve Activity and Short-Term Clinical Outcomes after Stroke: What Is Left May Not Be Right
Patients with left-sided strokes may have more severe strokes than those with right-sided ones, but adequate vagal nerve activity may protect against these differences.
Observational StudyThe Impact of Left versus Right Sided Strokes on Intracerebral Hemorrhage (P1.242)
In patients who received IV-tPA, intracerebral hemorrhage was not more likely to occur in patients with a right-side stroke compared to a left-side stroke, after controlling for age, severity, and time to tPA.
Observational Study
Very Rigorous JournalEffect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial)
Right insular involvement in acute ischemic stroke patients is associated with higher odds of death and worse functional outcomes compared to left-sided noninsular strokes.
Observational StudyVery Rigorous JournalIDENTIFYING THE CAUSE OF ISCHEMIC STROKE IN A YOUNG WOMAN USING MULTIMODALITY IMAGING
Ischemic stroke in young adults can be identified using multimodality imaging, allowing early treatment initiation and potentially preventing further complications.
Case ReportVery Rigorous JournalAbstract WP131: Correlation of Cardiac Derangement in Patients with Right-Sided Ischemic Stroke and the Severity of Insular Damage
Patients with right-sided ischemic stroke involving the insular cortex tend to have more severe cardiac damage, leading to higher levels of cardiac troponin T.
Observational StudyRigorous JournalCardiovascular autonomic function in poststroke patients
Post-acute stroke patients show a parasympathetic cardiac deficit and increased sympathetic cardiovascular modulation, potentially increasing their risk for cardiac arrhythmia due to unopposed sympathetic stimulation.
Observational Study
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