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Hemispheric differences in malignant middle cerebral artery stroke

Vaibhav Rastogi1, Damon G Lamb2, John B Williamson2

  • 1Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32611, United States.

Journal of the Neurological Sciences
|May 12, 2015
PubMed
Abstract

Insights

Malignant middle cerebral artery infarctions (MMCA) are more common in the right hemisphere, leading to worse outcomes. Further research is needed to understand this laterality and develop new treatments.

Area of Science:

  • Neurology
  • Stroke Medicine
  • Neuroimaging

Background:

  • Previous findings indicated worse outcomes for left vs. right hemisphere cerebral infarctions.
  • Clinical observations suggested a higher incidence of malignant middle cerebral artery infarctions (MMCA) in right-sided strokes.

Purpose of the Study:

  • To investigate if stroke laterality influences the severity and outcomes of MMCA.
  • To determine the association between hemispheric location and sequelae of MMCA.

Main Methods:

  • A systematic literature search was conducted on PubMed using keywords related to MMCA.
  • Data from 73 relevant studies were analyzed, encompassing 2673 patients with MMCA.

Main Results:

  • Right hemispheric involvement was more frequent in MMCA (63% of 2673 patients).
  • While mortality rates were comparable (31% right vs. 36% left), morbidity was significantly higher in right hemispheric MMCA.
  • Right MMCA occurred in 1687 patients, left in 144.

Conclusions:

  • MMCA appears to be more prevalent in the right hemisphere.
  • Right-sided MMCA is associated with increased morbidity.
  • Further prospective studies are required to elucidate the mechanisms of laterality and explore novel therapeutic strategies for MMCA.
Keywords:
Autonomic dysfunctionDecompressive hemicraniectomyInsulaLateralityMalignant middle cerebral artery strokeNorepinephrine

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