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Right-side Stroke by Rebecca J. Stahl, MA

Definition

The cerebrum, the largest part of the brain, is separated into the right and left hemispheres. The right hemisphere is in charge of the functions on the left-side of the body, as well as many cognitive functions.

A right-side stroke happens when the brain’s blood supply is interrupted in this area. Without oxygen and nutrients from blood, the brain tissue quickly dies. A stroke is a serious condition. It requires emergency care.

Causes

There are two main types of stroke:

Ischemic
Hemorrhagic

An ischemic stroke (the more common form) is caused by a sudden decrease in blood flow to a region of the brain, which may be due to:

A clot that forms in another part of the body (eg, heart or neck) breaking off and blocking the flow in a blood vessel supplying the brain (embolus)
A clot that forms in an artery that supplies blood to the brain (thrombus)
A tear in an artery supplying blood to the brain (arterial dissection)

A hemorrhagic stroke is caused by a burst blood vessel that results in bleeding in the brain.

Hemorrhagic vs. Ischemic Stroke

Risk Factors

Examples of risk factors that you can control or treat include:

Certain conditions, such as:
- High blood pressure
- High cholesterol
- High levels of the amino acid homocysteine (may result in the formation of blood clots)
- Atherosclerosis (narrowing of the arteries due to build-up of plaque)
- Atrial fibrillation (abnormal heart rhythm)
- Obesity
- Metabolic syndrome
- Type 2 diabetes
- Alcohol or drug abuse
Medicines (eg, long-term use of birth control pills )
Lifestyle factors (eg, smoking , physical inactivity, diet)

Risk factors that you cannot control include:

History of having a stroke, heart attack , or other type of cardiovascular disease
History of having a transient ischemic attack (TIA)—With a TIA, stroke-like symptoms often resolve within minutes (always in 24 hours). They may signal a very high risk of having a stroke in the future.
Age: 60 or older
Family members who have had a stroke
Gender: males
Race: Black, Asian, Hispanic
Blood disorder that increases clotting
Heart valve disease (eg, mitral stenosis )

Symptoms

The immediate symptoms of a right-side stroke come on suddenly and may include:

Weakness or numbness of face, arm, or leg, especially on the left side of the body
Confusion
Dizziness
Loss of balance, coordination problems
Vision problems, especially on the left-side of vision in both eyes
Difficulty swallowing
Headache

If you or someone you know has any of these symptoms, call 911 right away. A stroke needs to be treated as soon as possible.

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 make a diagnosis as quickly as possible. Tests may include:

Exam of nervous system
Computed tomography (CT) scan —a type of x-ray that uses a computer to make pictures of the brain
CT angiogram—a type of CT scan which evaluates the blood vessels in the brain and/or neck
Magnetic resonance imaging (MRI) scan —a test that uses magnetic waves to make pictures of the brain
Magnetic resonance angiography (MRA) scan —a type of MRI scan which evaluates the blood vessels in the brain and/or neck
Angiogram —a test that uses a catheter (tube) and x-ray machine to assess the heart and its blood supply
Heart function tests (eg, electrocardiogram , echocardiogram )
Doppler ultrasound —a test that uses sound waves to examine the blood vessels
Blood tests
Tests to check the level of oxygen in the blood
Kidney function tests
Tests to evaluate the ability to swallow

Treatment

Immediate treatment is needed to potentially:

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

In some cases, oxygen therapy is needed.

Medications

Medicines may be given right away for an ischemic stroke to:

Dissolve clots and prevent new ones from forming
Thin blood
Control blood pressure
Reduce brain swelling
Treat an irregular heart rate

Cholesterol medicines called statins may also be given.

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

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

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 (embolectomy)
Remove fatty deposits from a carotid artery (major arteries in the neck that lead to the brain) ( carotid artery endarterectomy )
Widen carotid artery and add a mesh tube to keep it open ( angioplasty and stenting )

For a hemorrhagic stroke, the doctor may:

Remove a piece of the skull ( craniotomy ) to relieve pressure on the brain and remove blood clot
Place a clip on or a tiny coil in the aneurysm to stop it from bleeding

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

To help reduce your chance of having a stroke, take the following steps:

Exercise regularly .
Eat a healthy diet that includes fruit, vegetables, whole grains, and fish.
Maintain a healthy weight.
If you drink alcohol , drink only in moderation (1-2 drinks per day).
If you smoke, quit .
If you have a chronic condition, like high blood pressure or diabetes, get proper treatment.
If recommended by your doctor, take a low-dose aspirin every day.
If you are at risk for having a stroke, talk to your doctor about taking statin medicines .

RESOURCES:

American Heart Association http://www.heart.org/HEARTORG/
National Stroke Association http://www.stroke.org/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index-eng.php
Heart and Stroke Foundation of Canada http://www.heartandstroke.com/
Stroke Survivors Association of Ottawa http://www.strokesurvivors.ca/

References:

Am I at risk for a stroke? National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=risk . Accessed April 22, 2011.
Anatomy of the brain. The University Hospital website. Available at: http://www.theuniversityhospital.com/stroke/anatomy.htm . Accessed April 22, 2011.
DynaMed Editorial Team. Prevention of stroke: recommendations. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated April 7, 2011. Accessed April 22, 2011.
DynaMed Editorial Team. Stroke (acute management): treatment overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated April 11, 2011. Accessed April 22, 2011.
Effects of stroke. Magee Rehabilitation website. Available at: http://www.mageerehab.org/effects-of-stroke.php . Accessed April 22, 2011.
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Effects of stroke. Rush University Medical Center website. Available at: http://www.rush.edu/rumc/page-1098987413801.html . Accessed April 22, 2011.
Right hemisphere brain damage. American-Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/speech/disorders/RightBrainDamage.htm . Accessed April 22, 2011.
Stroke and the brain. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/stroke/hic_stroke_and_the_brain.aspx . Accessed April 22, 2011.
Stroke: causes. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=causes . Updated July 1, 2010. Accessed April 22, 2011.
Stroke center. University of Chicago Medicine website. Available at: http://www.uchospitals.edu/specialties/neurology/stroke/ . Accessed April 19, 2012.
Stroke effects. American Hear Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4761 . Accessed April 22, 2011.
Stroke facts. St. John’s Hospital website. Available at: http://www.st-johns.org/services/stroke_center/stroke_facts.aspx. Accessed April 22 , 2011.
Stroke on the right side of the brain. University of Minnesota Medical Center website. Available at: http://www.uofmmedicalcenter.org/Services/Stroke/coping/right/index.asp . Accessed April 22, 2011.
Stroke: treatments and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=treatments-and-drugs . Accessed July 1, 2010. Accessed April 22, 2011.
Wood D. Stroke. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 28, 2011. Accessed April 22, 2011.

Last reviewed June 2012 by Rimas Lukas, MD

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