Healthcare Blog

Right-brain stroke could be underdiagnosed, The Lancet

August 01, 2017

People with stroke affecting the left side of the brain may be diagnosed more easily than those with right hemispheric stroke, according to a research letter in this week's issue of THE LANCET. The authors state that discrepancy could be due to difficulties in recognising the symptoms of right-brain stroke.

Cerebrovascular events are frequently accompanied by characteristic neurological deficits, depending on the side of the brain the lesion occurs. People with events on the left side of the brain may have difficulty with speech, while people with events on the right side of the brain might have awareness deficits. This difference could affect recognition of symptoms by patients, relatives, and doctors.

Christian Foerch (Goethe University, Frankfurt, Germany) and colleagues looked at the incidence of stroke using data from a stroke registry in Germany. Between 1997 and 2002 over 20,000 patients were included in the registry. Of these, 11,300 had left-brain stroke and 8,700 had events in the right hemisphere. The researchers found that compared with individuals with right-brain stroke, more patients with left-hemispheric events were treated with thrombolysis* and more were admitted to hospital within 3 hours of stroke onset.

Dr Foerch states: "In summary, our study suggests differences in medical attention and subsequent management between patients with right and left hemispheric stroke. Difficulties in recognition of symptoms due to right hemisphere stroke pose specific challenges for the effort to further optimise stroke management, particularly in the critical early hours of stroke."

In an accompanying comment John N Fink (Christchurch School of Medicine and Health Sciences, New Zealand) states: "Assuming that right-hemisphere stroke and left-hemisphere ischaemic events have equal frequency, Foerch and colleagues' data suggest that for every eight patients currently hospitalised for anterior-circulation stroke or transient ischemic attack, one person with a right-hemisphere ischaemic event will have been overlooked."

Contact: Dr Christian Foerch, Department of Neurology, Johann Wolfgang Goethe-University Frankfurt am Main, Schleusenweg 2-16, D-60528, Frankfurt, Germany. T) 69-6301-5486 foerchem.uni-frankfurt.de

Comment: Dr John N Fink, Department of Medicine, Christchurch
School of Medicine and Health Sciences, P.O. Box 4345
Christchurch, New Zealand. T) 64-3-364-0940
john.finkchmeds.ac.nz

*Treatment to dissolve abnormal clots that are restricting blood flow.

Lancet
thelancet