Thrombolysis in right versus left hemispheric stroke

Recent evidence has suggested that patients with right hemispheric stroke (RHS) present later to an emergency department, have a lower chance to receive intravenous (IV) recombinant tissue plasminogen activator (t-PA), and have poorer clinical outcomes than do patients with left hemispheric stroke (LHS).

We analyzed the rate of IV t-PA administration with respect to the side of the affected hemisphere in a large community population, to determine whether a difference exists. The study population was a large prospective cohort of patients with acute stroke treated with IV t-PA at our hospital's stroke center (October 2000 to October 2006).

Of 2,932 patients presenting with ischemic stroke, 953 met criteria for study inclusion. In all, 151 patients received IV t-PA. Between groups, there was no significant difference in presentation within 3 hours after acute stroke (P=.180). There was no difference in the use of IV t-PA between patients with RHS and LHS (P=.237).

There was no difference with respect to affected hemisphere in time to presentation to the emergency department. Furthermore, there was no difference in the rate of IV t-PA administration for patients with RHS versus LHS. This finding is in contrast to previous research on IV t-PA use in hemispheric stroke and may reflect improved recognition of right hemispheric syndromes.