Foerch C et al. (2005) Difference in recognition of right and left hemispheric stroke. Lancet 366: 392–393

Left-hemispheric and right-hemispheric strokes have different characteristic symptoms; for instance, left-hemispheric stroke can cause aphasia, whereas right-hemispheric stroke is associated with neglect. The symptoms of right-hemispheric stroke can be difficult to recognize, raising concerns about the adequacy of clinical management in this patient group. A recent German study has examined the impact of such symptom differences on patient treatment, particularly with regard to admission to hospital.

Foerch and colleagues carried out statistical analysis of data from 20,097 stroke patients (mean age 70 years) who had received inpatient care for their condition—patients had sustained a transient ischemic attack, a cerebral infarction or an intracerebral hemorrhage. The data included information on stroke side and localization, stroke severity and cause, vascular risk factors, and time between the onset of symptoms and admission to hospital.

Overall, 11,328 patients were diagnosed with a left-sided stroke, and 8,769 with a right-sided stroke (P <0.0001). Fifty-eight percent of patients who received thrombolytic treatment had suffered a left-hemispheric stroke, and a larger proportion of left-hemispheric than right-hemispheric stroke patients received treatment within 3 hours. Overall, more patients were admitted to hospital with left-hemispheric than with right-hemispheric stroke, yet there is no evidence that left-hemispheric stroke occurs more frequently in the general population.

The findings of this study indicate that the poorer recognition of symptoms associated with right-hemispheric stroke, in particular during the first few hours after an event, leads to an inequality in the medical treatment and management of patients with left-hemispheric and right-hemispheric stroke.