Right hemispheric stroke symptoms
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Symptoms of Right Hemispheric Stroke
Right hemispheric strokes can lead to a variety of neuropsychological and physical symptoms that significantly impact a patient's daily life. Understanding these symptoms is crucial for effective diagnosis and rehabilitation.
Anosognosia and Neglect
Anosognosia for Visuospatial Deficits
Anosognosia, or the lack of awareness of one's own deficits, is a common symptom following a right hemispheric stroke. This condition particularly affects visuospatial abilities, making it a significant predictor of difficulties in performing activities of daily living (ADL). Patients with anosognosia often fail to recognize their impairments, which complicates rehabilitation efforts.
Visuospatial Neglect
Visuospatial neglect, where patients ignore one side of their visual field, is another frequent consequence of right hemispheric strokes. This condition can occur independently or alongside visual extinction, where patients fail to notice stimuli on the affected side when presented simultaneously with stimuli on the unaffected side. Neglect is associated with damage to the fronto-parietal brain regions, particularly the parieto-occipital and dorsal fronto-parietal areas.
Visual Extinction and Lesion Sites
Visual Extinction
Visual extinction is characterized by the inability to perceive multiple stimuli simultaneously, particularly when they are presented bilaterally. This symptom is often linked to lesions in the right inferior parietal cortex. The co-occurrence of visual extinction and neglect suggests that these conditions, while related, can also manifest independently, indicating distinct neural substrates.
Lesion Mapping
Lesion-symptom mapping has shown that damage to the right frontal and cingulate cortex, as well as adjacent white matter, significantly impacts ADL performance. These findings highlight the importance of assessing specific brain regions to predict and manage stroke outcomes effectively.
Vestibular Symptoms
Vertigo and Dizziness
Vestibular symptoms such as vertigo, dizziness, and gait instability are more frequently observed in patients with right hemispheric strokes. These symptoms are often associated with lesions in the middle cerebral artery territory, particularly in areas like the insula, retro-insular region, and superior/middle temporal gyrus. However, not all lesions in the parieto-insular vestibular cortex (PIVC) or temporo-periSylvian vestibular cortex (TPSVC) result in vestibular symptoms, indicating a complex relationship between lesion location and symptom manifestation.
Cognitive and Behavioral Symptoms
Hemispatial Neglect
Hemispatial neglect, particularly left hemispatial neglect (LHN), is a significant cognitive deficit following right hemispheric strokes. Patients with LHN struggle to attend to and respond to stimuli on their left side. Rehabilitation protocols combining repetitive transcranial magnetic stimulation (r-TMS) and visual scanning treatments have shown promise in alleviating these symptoms.
Complex Regional Pain Syndrome (CRPS)
CRPS can also develop following a right hemispheric stroke, often associated with poor blood sugar control. This condition is characterized by persistent pain and changes in skin color and temperature, linked to abnormal thalamic blood flow.
Stroke Assessment and Management
Underestimation of Symptoms
Right hemispheric stroke symptoms are often underestimated in clinical assessments, leading to larger infarct volumes and higher risks of secondary complications like intracerebral hemorrhage after thrombolysis. This underestimation underscores the need for improved diagnostic tools and awareness to optimize stroke management, especially in the critical early hours.
Conclusion
Right hemispheric strokes result in a range of symptoms, including anosognosia, visuospatial neglect, visual extinction, vestibular symptoms, and cognitive deficits. Accurate assessment and targeted rehabilitation are essential for improving patient outcomes. Understanding the specific neural substrates and lesion locations associated with these symptoms can guide more effective treatment strategies.
Sources and full results
Most relevant research papers on this topic