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Right-Brain Strokes Often Missed

More subtle symptoms difficult to detect, studies say

THURSDAY, July 28, 2005 (HealthDay News) -- Someone who suffers a stroke that damages the right side of the brain is likely to get less effective treatment than someone whose stroke strikes the left side of the brain, researchers report.

That is because the symptoms of a left-side stroke are easier to detect, since that side controls speech, two new studies from neurologists in Germany and Canada note. The German research appears in this week's issue of The Lancet, while the Canadian report appeared earlier this month in Neurology.

By contrast, a right-side stroke causes more subtle defects, mostly in awareness, explained Dr. Vladimir Hachinski, a professor of neurology at the University of Western Ontario, and a member of the Canadian research team.

The German researchers focused on more than 20,000 stroke patients. Approximately 11,300 of the participants had suffered a left-brain stroke and 8,700 had experienced a right-side attack.

The investigators report that those with left-side strokes were more likely to be admitted to the hospital within three hours after suffering the stroke, and were also more likely to get clot-dissolving drugs quickly.

Stroke affecting the brain's right hemisphere "do not appear as critical as left-brain strokes, and therefore do not get urgent treatment," said study author Dr. Christian Foerch, a neurologist at Goethe University in Frankfurt.

The finding has implications "for everyone who cares for acute stroke patients, such as paramedics and house doctors," Foerch said. "They must learn to recognize right-brain stroke, and bring patients rapidly to treatment."

The Canadian report on 990 stroke patients showed similar patterns. Right-side stroke patients were 45 percent less likely to be given a clot-dissolving drug, and they spent an average of 15 days in the hospital, compared to the average nine-day stays of left-side stroke patients.

The difficulty in detecting right-side stroke begins with the patients themselves, Hachinski explained. "If something happens, it doesn't occur to them that something is wrong," he said. "So, they delay coming to the emergency department."

When they do get to the hospital, emergency room doctors can then fumble the diagnosis, Hachinski added, "because the scales we use are not good at detecting this problem."

Friends and relatives need to be alert, Hachinski said. "People with right-brain strokes are not aware that they are not aware," he said. "If relatives or someone else close to the person has any doubt that something has happened, they should call 911. It is better to have a few cases that are not stroke than to have a stroke that is ignored."

A major characteristic of a right-side stroke is that "people neglect the left half of their space," Hachinski noted. "They don't recognize what their left hand is doing. If they eat food, they eat from the right side of the plate, not the left."

He said that his group is working on measures to help hospital personnel recognize right-side strokes. "We are working with a neurological scale, trying to add on a simple examination so that they can pick up these difficulties," Hachinski said. "We hope that by doing that we can make identification available to a much broader range of people."

More information

What you should know about stroke is available from the National Institute of Neurological Diseases and Stroke.

SOURCES: Vladimir Hachinski, M.D., professor, neurology, University of Western Ontario, London, Canada; Christian Foerch, M.D., neurologist, Goethe University, Frankfurt, Germany; July 30, 2005, The Lancet; July 12, 2005 Neurology
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