Right-sided vs left-sided stroke

Strokes occur when blood flow to the brain is disrupted, either by a blockage or bleeding in the brain. Every stroke is different. Symptoms vary depending on the type, severity and location where the stroke occurred. Most are either a left-sided stroke or right-sided stroke. 

Understanding stroke

Wherever it occurs, a stroke is always an emergency because with every minute that passes, more brain cells are lost.

“Every stroke is unique, and each individual’s recovery journey is different,” said Victoria Van Cura, a board-certified neurologic clinical specialist and a physical therapist at Encompass Health Rehabilitation Institute of Libertyville in Illinois. “Two people sitting next to each other can experience a stroke in the same part of the brain and have totally different experiences.”

Types of stroke

There are different types of stroke, which are generally categorized based on whether blood flow to the brain is blocked or bleeding occurs within the brain.

Ischemic stroke

An ischemic stroke is the most common, which is caused by a blockage either from blood clots or buildup of plaque in a blood vessel.

Hemorrhagic stroke

Hemorrhagic strokes are caused by a leaky or ruptured artery in the brain. This type of stroke can be caused by an aneurysm, a bulge in the artery that can rupture or leak. Another common cause is high blood pressure, which increases resistance in the arteries.

Recognizing the symptoms of stroke

The American Stroke Association uses the acronym B.E. F.A.S.T. to educate the public on the warning signs of stroke and the importance of acting quickly. Regardless of where a stroke occurs, recognizing the symptoms and seeking immediate medical care is vital.

B — Balance. A sudden loss or change in balance.
E — Eyes. A change in vision such as loss of visual field or double vision.

 

F — Face. Facial drooping on one side of the face, especially noticeable with smiling.
A — Arm. Weakness or numbness in one arm (or even in the legs) could be a sign of stroke. One arm might drift downward when raised out in front.
S — Speech. Slurring or strange speech or aphasia.
T — Time. If you observe any of these signs, it is important to call 911 immediately.

Other warning signs of a stroke

The American Stroke Association lists the following as other stroke warning signs:

• Numbness in the arm, leg or face on one side of the body
• Changes in feeling or behavior
• Loss of consciousness
• Nausea or fever
• Problems swallowing, trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Trouble walking including dizziness and loss of balance or coordination
• Severe headache with no known cause

While the above symptoms send a warning alert for stroke, the area of the brain where the stroke occurred can determine the deficits one might experience. A stroke on one side of the brain results in neurological impairments on the opposite side of the body.

General effects of a stroke

• Muscle weakness/paralysis
• Vision problems
• Impaired cognition — difficulty understanding or memory loss
• Changes in muscle tone — hypertonicity, spasticity, hypotonicity or flaccidity
• Impaired balance or dizziness 

Deficits from a right-sided stroke

The largest portion of the brain is known as the cerebral cortex. It contains both a right and left hemisphere. Strokes that occur in the right hemisphere are referred to as right-sided strokes.

Effects that may be seen after a right-sided stroke include:

• Weakness or paralysis on the left side of the body
• Sensory issues, such as numbness or pain, on the left
• Vision problems including loss of vision in left field of each eye (homonymous hemianopsia) or impaired depth perception
• Hearing difficulties
• Memory problems
• Changes in cognition and behavior, such as impulsiveness, depression, flattened affect, loss of focus or shortened attention span
• Difficulty with spatial reasoning and awareness or left spatial neglect. This can cause bumping into objects on the left side or the inability to read words on the left side of a page.

Effects of a left-sided stroke

A left-sided stroke leads to neurological impairment on the right side of the body.

Effects that might be seen with a left-sided stroke include:

• Weakness or paralysis on the right side of the body
• Speech or language difficulties including aphasia (inability to process, use or understand language)
• Behavioral changes, such as increased caution, being easily frustrated and requiring frequent feedback
• Memory loss
• Impaired reasoning skills

Risk factors for stroke

There are certain factors that place a person at a higher risk for stroke. Some risk factors are modifiable, while others are not. Modifiable risk factors can be reduced with lifestyle changes. Knowing the risks is an important step in preventing stroke:

Non-modifiable risk factors

• Age. Risk increases after age 55
• Family history. Stroke risk is increased with a family history
• Race. Black Americans have a higher risk of stroke, according to the American Stroke Association
• Gender. More women have strokes than men after the age of 75, and strokes are more deadly for women
• Previous stroke or TIA. Prior stroke or transient ischemic attacks significantly increase future stroke risk

Modifiable risk factors and prevention

• Physical inactivity. Exercise regularly and stay active. Around 20-60 minutes of aerobic exercise three to five days a week and two to three days of strength training.
• Smoking/alcohol use. Stop smoking and only drink in moderation
• Diabetes. Manage with exercise, diet and prescribed medication
• High cholesterol. Reduce saturated fats, trans-fats and cholesterol
• High blood pressure. Monitor regularly, avoid stress and follow prescribed medication
• Heart disease. Manage conditions such as atrial fibrillation and coronary artery disease (CAD)

Stroke recovery and rehabilitation

Stroke survivors will greatly benefit from stroke rehabilitation, often in an inpatient rehabilitation setting. A quality rehabilitative program can help individuals who have strokes regain strength, mobility and independence.

The American Heart Association/American Stroke Association's adult stroke rehabilitation guidelines state that, "whenever possible, initial rehabilitation should take place in an inpatient rehabilitation facility rather than a nursing home." As opposed to a skilled nursing facility, patients at an inpatient rehabilitation hospital will receive three hours of therapy, five days a week. Patients will also receive frequent physician visits and 24/7 nursing care.

“Early participation in inpatient rehabilitation and individualized therapy is essential to maximizing recovery and achieving functional and personal goals,” Van Cura said.

Rehabilitation should be implemented as soon as the patient is medically stable. Rehabilitation services are based on specific needs. Care teams focus on weakness or paralysis, poor balance, tone management, impaired functional mobility and cognitive dysfunction.

Rehabilitation services may include:

• Physical therapy to restore strength and functional mobility, with an emphasis on walking
• Occupational therapy to improve Activities of Daily Living such as eating, dressing, toileting and bathing
• Speech therapy to improve communication, swallowing or cognitive deficits
• Additional support services, including nursing care, pain management, pharmaceutical needs, emotional and psychiatric support and community support through therapy groups or support groups

This article was clinically reviewed by Victoria Van Cura, PT, DPT, NCS, MHA. Van Cura is a board-certified neurologic clinical specialist with four years of experience as a physical therapist, including the past three years at Encompass Health Rehabilitation Institute of Libertyville, Illinois. Van Cura is residency trained in neurological physical therapy and specializes in the treatment and rehabilitation of individuals recovering from stroke, spinal cord injury and vestibular disorders. She is passionate about helping patients maximize their independence, mobility and quality of life through individualized, evidence-based care.