Right-brain strokes harder to diagnose

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The findings from a study in Germany suggest that because of differences in symptoms, Strokes affecting the right side of the brain may be underdiagnosed compared with to those affecting the left side.

Because of the way the brain and body interact, strokes on the left side of the brain can cause movement problems on the right side of the body and visa-versa. Still, these signs might not be obvious, so doctors look for other symptoms as well.

With a left-brain Stroke, patients may have difficulty understanding words or speaking themselves. By contrast, the symptoms of a right-brain Stroke are much more subtle.

"Our study suggests differences in medical attention and subsequent management between patients with right and left (brain) stroke,” lead author Dr. Christian Foerch, from Johann Wolfgang Goethe University in Frankfurt, and colleagues note. Correctly identifying the symptoms of right-brain stroke is critical for optimal treatment, they add.

One factor that may help explain the difference in Stroke recognition is the symptom scoring sheets doctors use to evaluate stroke patients. Many of these sheets are simply better suited to detecting the symptoms of a left-brain stroke rather than a right-brain one.

The study findings, which appear in The Lancet, are based on an analysis of data from a large hospital-based stroke registry in Germany. Data from more than 20,000 patients were included in the analysis.

Fifty-six percent of patients had left brain strokes, while 44 percent had right brain strokes. The authors believe a diagnostic bias may have been involved because age, stroke severity, and the period from symptom onset to hospital admission were all significantly linked to left-brain stroke.

In a related editorial, Dr. John N. Fink, from Christchurch School of Medicine and Health Sciences in New Zealand, comments that contrary to what might be believed, stroke diagnosis is not simple.

He adds that it is “up to physicians who assess patients with stroke to train other physicians, and organize stroke services to improve our standard of (diagnostic) performance.”

SOURCE: The Lancet, July 30, 2005.

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