Abstract WP160: Delirium in Right Hemisphere Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sara K Rostanski ◽  
Marykay A Pavol ◽  
Marissa Barbaro ◽  
Minji Kim ◽  
Randolph S Marshall ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Cognitive Status ◽  
Screening Tools ◽  
Stroke Patients ◽  
Altered Level ◽  
Stroke Registry ◽  
Public Health Burden ◽  
Systematic Assessment ◽  
Right Hemisphere Stroke

Introduction: Delirium, a disorder of attention and arousal, poses a large public health burden. Inattention and fluctuating cognitive status, two primary delirium symptoms, also occur when specialized right brain systems are impaired. Although right hemisphere stroke may predispose to delirium, systematic assessment methods and management of these patients are not yet available. We sought to characterize the incidence of delirium in right hemisphere stroke patients and explore whether stroke localization was associated with delirium. Methods: We identified consecutive patients admitted to our stroke service with acute right hemisphere stroke over a 6-month period from our prospective stroke registry. We reviewed the medical record for core delirium symptoms: inattention, cognitive fluctuation, and either disorganized thinking, or altered level of consciousness. Delirium was assessed by systematically screening for trigger words. We compared baseline characteristics with Fisher’s exact and t-tests and assessed relation of stroke localization to delirium with logistic regression. Results: Of 105 patients with acute right hemisphere stroke, 27 (26%) had delirium. Delirium patients were older (mean age 78 vs. 68, p<0.01), more likely to have dementia (30% vs. 5%, p<0.01) and prior stroke (52% vs. 28%, p=0.03). Median length of stay was longer (5 vs. 3 days, p<0.01), and discharge home less likely (37% vs. 64%, p=0.01) in those with delirium. Delirium patients more often had strokes involving the parietal lobe (44% vs. 17%, p<0.01). In a multivariable model, parietal localization strongly predicted incident delirium (OR 3.6 95%CI 1.1-11.3, p=0.03) adjusting for age, baseline NIHSS, and premorbid dementia. Conclusion: The high delirium incidence we found supports routine delirium screening in acute stroke patients. Stroke localization may be one factor to incorporate into screening tools. Studies to prospectively identify and treat delirium in both right and left hemisphere stroke patients are warranted.

scholarly journals Is Lateropulsion Really Related with a Specific Lesion of the Brain?

2021 ◽  
Vol 11 (3) ◽  
pp. 354
Author(s):  
Kyoung Lee ◽  
Sang Yoo ◽  
Eun Ji ◽  
Woo Hwang ◽  
Yeun Yoo ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Inferior Frontal Gyrus ◽  
Brain Lesions ◽  
Vertical Posture ◽  
Lesion Volume ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
The Right ◽  
Right Hemisphere Stroke

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.

Assessing visual extinction in right-hemisphere stroke patients with and without neglect

2010 ◽  
Vol 41 (01) ◽  
Author(s):  
S Vossel ◽  
P Eschenbeck ◽  
P Weiss ◽  
G Fink
Keyword(s):  
Right Hemisphere ◽  
Stroke Patients ◽  
Visual Extinction ◽  
Right Hemisphere Stroke

scholarly journals The Presence of Visual Neglect after Thrombolytic Treatment in Patients with Right Hemisphere Stroke

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
J. E. Kettunen ◽  
M. Nurmi ◽  
A.-M. Koivisto ◽  
P. Dastidar ◽  
M. Jehkonen
Keyword(s):  
Right Hemisphere ◽  
Stroke Severity ◽  
Study Group ◽  
Thrombolytic Treatment ◽  
Visual Neglect ◽  
Stroke Patients ◽  
Neuropsychological Examination ◽  
The Difference ◽  
Right Hemisphere Stroke

Visual neglect (VN) is a common consequence of right hemisphere (RH) stroke. The aims of this study were to explore the presence of VN after RH stroke in the patients with (T+) or without (T−) thrombolytic treatment, and to determine whether thrombolysis is a predictor of VN. The study group consisted of 77 RH infarct patients. VN was evaluated with six conventional subtests of the Behavioural Inattention Test (BIT). Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS). In the neuropsychological examination, 22% of all RH stroke patients had VN. VN was present in 15% of the patients in the T+ group and in 28% of the patients in the T− group, but the difference was not statistically significant. Despite that, patients in the T− group had a higher risk of VN than patients in the T+ group. Our results suggest that thrombolysis independently predicted absence of VN.

Abstract WP292: Temporal Trends in the Use of Ems Service as a Mode of Arrival by Acute Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Lee H Schwamm ◽  
Sanjeeva Onteddu ◽  
Krishna Nalleballe ◽  
Kelly-Ann Patrice ◽  
...  
Keyword(s):  
African Americans ◽  
Univariate Analysis ◽  
Temporal Trends ◽  
Stroke Patients ◽  
Altered Level ◽  
Stroke Registry ◽  
Stroke Risk Factors ◽  
The Us ◽  
Ems Education ◽  
Iv Tpa

Intro: Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with IV tPA or endovascular intervention. We investigate the use of EMS services in three large states across the US during the past decade. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 9,251 stroke admissions from 01/2010 - 12/2018. Overall rates of EMS use and temporal trends were computed. Factors associated with EMS use were evaluated with univariate analysis. Results: Of the 9,251 patients, 29.2 % (2,697/9,251) presented via EMS service. Overtime use of EMS service increased from 29% in 2010-11 to 34% in 2018. Use of EMS increased among severe stroke patients but decreased among mild stroke patients. Patients presenting via EMS were older, more often females while less often African Americans. They had more stroke risk factors, including hypertension, diabetes, atrial fibrillation and previous stroke/TIA. Smokers less often use EMS services. Median NIHSS was higher among patients presenting via EMS, and those with altered level of consciousness used EMS more often. In-hospital intervention rates (IV tPA/endovascular) were higher among patients presenting via EMS. Conclusion: Our results showed that after extensive EMS education in most parts of the study states, stroke presentation has increased via EMS overtime. Disparity in the use of EMS still exists with African Americans using the service less often. Patients should be encouraged to use EMS services and decrease delay in presentation which can results in higher rates of intervention.

Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting

1993 ◽  
Vol 74 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Lisa J. Rapport ◽  
Jeffrey S. Webster ◽  
Kirstin L. Flemming ◽  
John W. Lindberg ◽  
M. Catherine Godlewski ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Stroke Patients ◽  
Right Hemisphere Stroke

FV15 Revisiting the concept of apraxia in the right hemisphere: Evidence from 139 acute right hemisphere stroke patients

2020 ◽  
Vol 131 (4) ◽  
pp. e230-e231
Author(s):  
A. Dreßing ◽  
L.A. Beume ◽  
M. Martin ◽  
D.Kümmerer ◽  
H. Urbach ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Stroke Patients ◽  
The Right ◽  
Right Hemisphere Stroke

scholarly journals Impaired Recognition of Emotional Faces after Stroke Involving Right Amygdala or Insula

2018 ◽  
Vol 39 (01) ◽  
pp. 087-100 ◽  
Author(s):  
Brittany Godin ◽  
Kumiko Oishi ◽  
Kenichi Oishi ◽  
Cameron Davis ◽  
Yessenia Gomez ◽  
...  
Keyword(s):  
Facial Expressions ◽  
Right Hemisphere ◽  
Anterior Insula ◽  
Human Anatomy ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Emotional Faces ◽  
The Right ◽  
Right Hemisphere Stroke

AbstractDespite its basic and translational importance, the neural circuitry supporting the perception of emotional faces remains incompletely understood. Functional imaging studies and chronic lesion studies indicate distinct roles of the amygdala and insula in recognition of fear and disgust in facial expressions, whereas intracranial encephalography studies, which are not encumbered by variations in human anatomy, indicate a somewhat different role of these structures. In this article, we leveraged lesion-mapping techniques in individuals with acute right hemisphere stroke to investigate lesions associated with impaired recognition of prototypic emotional faces before significant neural reorganization can occur during recovery from stroke. Right hemisphere stroke patients were significantly less accurate than controls on a test of emotional facial recognition for both positive and negative emotions. Patients with right amygdala or anterior insula lesions had significantly lower scores than other right hemisphere stroke patients on recognition of angry and happy faces. Lesion volume within several regions, including the right amygdala and anterior insula, each independently contributed to the error rate in recognition of individual emotions. Results provide additional support for a necessary role of the right amygdala and anterior insula within a network of regions underlying recognition of facial expressions, particularly those that have biological importance or motivational relevance and have implications for clinical practice.

Touch and feel? Using the rubber hand paradigm to investigate self-touch enhancement in right-hemisphere stroke patients

2010 ◽  
Vol 48 (1) ◽  
pp. 26-37 ◽  
Author(s):  
Rebekah C. White ◽  
Anne M. Aimola Davies ◽  
Udo Kischka ◽  
Martin Davies
Keyword(s):  
Right Hemisphere ◽  
Stroke Patients ◽  
Rubber Hand ◽  
Right Hemisphere Stroke
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