Left-Sided Neurological Symptoms and Negative Diffusion-Weighted MRI in Suspected Minor Stroke Patients

Area of Science:

• Neurology
• Neuroimaging
• Stroke Research

Background:

• Functional neurological symptoms are historically theorized to be more prevalent on the left side, linked to right hemisphere processing.
• Objective imaging evidence supporting this theory has been limited.

Purpose of the Study:

• To investigate if acute left-sided symptoms (right hemisphere) in minor stroke patients are more likely to present with negative diffusion-weighted imaging (DWI) compared to right-sided symptoms.
• To explore potential lateralization in neurological symptom presentation and neuroimaging findings.

Main Methods:

• Analysis of data from the prospective, multicenter SpecTRA cohort study (2013-2017).
• Inclusion of patients with mild, persistent unilateral hemiparesis and/or hemisensory symptoms (NIH Stroke Scale ≤ 3) with available DWI.
• Primary outcome was the proportion of patients with negative DWI results.

Main Results:

• Out of 584 included patients, 30.8% presented with left-sided symptoms.
• A higher proportion of patients with left-sided symptoms (58.9%) had negative DWI compared to those with right-sided symptoms (41.1%).
• Left-sided hemiparesis showed a significant association with negative DWI (RR 1.42), while left-sided hemisensory symptoms did not (RR 1.11).

Conclusions:

• Unilateral left-sided neurological symptoms were more frequently associated with negative DWI in suspected minor stroke patients.
• This exploratory observation warrants further investigation into the final diagnosis of DWI-negative cases to establish definitive conclusions.