Right-side Stroke

Definition

The cerebrum is the largest part of the brain. It is made of a left and a right hemisphere. In most people, the right hemisphere is in charge of the functions on the left-side of the body and many cognitive functions.

A right-side stroke happens when the blood supply to the left side of the brain is interrupted. Without oxygen and nutrients from blood, the brain tissue quickly dies.

There are two main types of stroke ischemic and hemorrhagic. An ischemic stroke is the most common type of stroke.

Causes

An ischemic stroke is caused by a blockage of the blood flow, which may be due to:

A clot from another part of the body like the heart or neck. The clot breaks off and flows through the blood until it becomes trapped in a blood vessel supplying the brain.
A clot that forms in an artery that supplies blood to the brain.
A tear in an artery supplying blood to the brain. Called an arterial dissection.

A hemorrhagic stroke is caused by a burst blood vessel. Blood spills out of the broken blood vessel and pools in the brain. This interrupts the flow of blood and causes a build up of pressure on the brain.

Hemorrhagic vs. Ischemic Stroke

Risk Factors

Factors that may increase your risk of stroke include:

Sex: Men are more likely to have strokes than women but women are more likely to die of strokes than men
African American, Hispanic or Asian/Pacific Islander descent
Age: Risk of stroke increases with age particularly after 55 years of age.
Family history of stroke

Medical conditions that can increase your risk of stroke include:

High blood pressure (the number one risk factor for ischemic stroke)
High blood homocysteine level
Atherosclerosis
High cholesterol levels—specifically high-LDL "bad" cholesterol
Diabetes mellitus or impaired glucose tolerance
Atrial fibrillation
Blood disorders such as sickle cell disease and polycythemia
Disease of heart valves, such as mitral stenosis
Prior stroke or cardiovascular disease, such as heart attack
Peripheral artery disease
Transient ischemic attack (TIA) —a "warning stroke" with stroke-like symptoms that go away shortly after they appear
Conditions that increase your risk of blood clots such as:
- Cancer
- Pregnancy
- Certain autoimmune diseases
Having a blood vessel abnormality

Lifestyle factors that can increase your risk of stroke include:

Drug abuse (heroin, cocaine, amphetamines)
Smoking
Use of birth control pills, especially if you are over 35 years old and smoke
Long-term use of hormone replacement therapy
Physical inactivity
Alcohol abuse

Symptoms

Symptoms occur suddenly. Exact symptoms will depend on the part of the brain affected. Rapid treatment is important to decrease the amount of brain damage. Brain tissue without blood flow dies quickly.

Call for medical help right away if you notice any of the following:

Sudden weakness or numbness of face, arm, or leg, especially on the left side of the body
Sudden confusion
Sudden trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden dizziness, trouble walking, loss of balance, or coordination
Sudden severe headache with no known cause
Difficulty understanding or expressing the tone of language
Difficulty with learned movements
Lack of attention to the left side of the body

If you or someone you know has any of these symptoms, call for medical help right away. Brain tissue without blood flow dies quickly.

Longer-lasting effects of the stroke may include problems with:

Left-sided weakness and/or sensory problems
Speaking and swallowing
Vision (eg, inability for the brain to take in information from the left visual field)
Perception and spatial relations
Attention span, comprehension, problem solving, judgment
Emotions
Interactions with other people
Activities of daily living (eg, going to the bathroom)
Mental health (eg, depression , frustration, impulsivity)

Diagnosis

The doctor will do a physical exam and look for muscle weakness, visual and speech problems, and movement difficulty. If possible, you will be asked about your symptoms and medical history. Your doctor may use a CT scan or MRI scan of the brain to confirm a stroke or rule out other conditions.

Your doctor may also order tests that create detailed images of blood vessels. These test will help see which blood vessels may be creating the problem:

Magnetic resonance angiography (MRA)—maps blood flow
CT angiogram (CTA)—creates detailed images of the blood vessels and their blood flow
Doppler ultrasound—evaluates flow of blood in the head and neck

Blood tests can also help determine if there is a bleeding problem.

Treatment

Immediate treatment is needed to:

Dissolve or remove a clot causing an ischemic stroke
Stop the bleeding during a hemorrhagic stroke

Oxygen therapy may be needed.

Medications

For an ischemic stroke, medication may be given to:

Dissolve clots and prevent new ones from forming
Thin blood
Control blood pressure
Treat an irregular heart rate
Treat high cholesterol

For a hemorrhagic stroke, the doctor may give medication to:

Work against any blood-thinning drugs you may regularly take
Prevent seizures
Reduce how your brain reacts to bleeding
Control blood pressure

Surgery

For an ischemic stroke, procedures may be done to:

Reroute blood supply around a blocked artery.
Remove the clot or deliver clot-dissolving medicine.
Remove fatty deposits from a arteries in the neck.
Widen carotid artery and add a mesh tube to keep it open.

For a hemorrhagic stroke, the doctor may:

Place a clip or tiny coil in the aneurysm to stop it from bleeding.
Remove a piece of the skull to relieve pressure on the brain.

Rehabilitation

A rehabilitation program focuses on:

Physical therapy—to regain as much movement as possible
Occupational therapy—to assist in everyday tasks and self-care
Speech therapy—to improve swallowing and speech challenges
Psychological therapy—to help adjust to life after the stroke

Prevention

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:

Exercise regularly.
Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
Stop smoking .
Increase your consumption of fish.
Drink alcohol only in moderation (1-2 drinks per day).
Maintain a healthy weight.
Check blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
Take aspirin if your doctor says it is safe.
Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
Seek medical care if you have symptoms of a stroke, even if symptoms stop.
Stop the use of recreational drugs (eg, cocaine, heroin, amphetamines).

RESOURCES

American Heart Association http://www.americanheart.org/

National Stroke Association http://www.stroke.org/

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

Stroke Survivors Association of Ottawa http://www.strokesurvivors.ca/

References

Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke . 2010 October 21. Available at: http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181f7d043v1 . Updated October 21, 2010. Accessed September 4, 2012.

Hemorrhagic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds%5FUCM%5F310940%5FArticle.jsp. Accessed June 6, 2013.

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Raychev R, Saver JL. Mechanical thrombectomy devices for treatment of stroke. Neurol Clin Practice. 2012;2(3):231-235.

Signs and symptoms. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP . A Accessed September 4, 2012.

Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

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Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 05/2013 -
Update Date: 06/11/2013 -

Redmond Regional Medical Center