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Título

Clinical Significance of the Cerebral Lesion’s Side in Ischemic Stroke

Resumo

Background: Stroke is a cerebrovascular disease that can affect both hemispheres and cause functional dependence. The structural and functional symmetry of the right and left sides of the brain is not absolute. Some differences in the two hemispheres have already been demonstrated. The left side of the brain is more associated with the ​​language, logic and problem solving, while the right side is associated with emotions, empathy and visuospatial tasks. Furthermore, about 90% of individuals have the right hand as dominant, which is controlled by the contralateral motor cortex. Structural and physiological changes are involved in this differentiation, for example, there is an increase in the length of the central sulcus in the left hemisphere for right-handers and in the right for left-handers demonstrated in some studies. Objective: Evaluate possible changes in the functional outcome of right-handed patients who had an ischemic stroke in the right hemisphere compared to the left. Methodology: Prospective cohort with patients from the Stroke Intensive Care Unit of Hospital Geral Roberto Santos. Patients were analyzed in relation to their handedness, a question asked directly to the patient or family members. Right-handed patients were kept for analysis, while left-handed patients were excluded due to their reduced number. The affected hemisphere was collected from medical records. For the outcome, functional dependence (mRS>2) was evaluated using the modified Rankin scale performed 90 days post-ictus. Patients with previous stroke and who died were excluded from the analysis. Result: Of the 132 patients analyzed, 69 (52.3%) were male with an average age of 58.1 (±40.5), those with stroke in the right hemisphere had a higher risk of functional dependence (42.3% vs 27.8%, RR=1.52). With the chi-square test, there was no statistical significance in the association of the affected hemisphere and the functional outcome (p=0.088). Conclusion: The percentage of patients with functional dependence was higher in patients with stroke in the right hemisphere, but the p-value didn’t show statistical significance. Patients with ischemic stroke in the dominant hemisphere may be more likely to develop functional difficulties. The dominant hand is used for activities that require precision, such as writing. Mild functional independence can lead to disabling deficits in patients pos-stroke.

Palavras Chave

stroke, functional dependence, hemisphere, handedness