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. 2003 Jul;74(7):889–892. doi: 10.1136/jnnp.74.7.889

Lack of hemispheric dominance for consciousness in acute ischaemic stroke

B Cucchiara 1, S Kasner 1, D Wolk 1, P Lyden 1, V Knappertz 1, T Ashwood 1, T Odergren 1, A Nordlund 1
PMCID: PMC1738543  PMID: 12810773

Abstract

Background: Previous reports have suggested left hemispheric dominance for maintaining consciousness, although there is controversy over this claim.

Objective: To compare early impairment of level of consciousness between patients with right and left hemispheric stroke.

Methods: Data from 564 patients with ischaemic stroke enrolled in the placebo arm of a trial of a putative neuroprotectant were analysed. All patients had major hemispheric stroke with cortical dysfunction, visual field deficit, and limb weakness, with symptom onset within 12 hours of enrolment. Patients were prospectively evaluated on a predefined scale (1–6; 1 = fully awake, higher scores representing greater impairment) to measure level of consciousness at multiple time points over the initial 24 hours after presentation. The National Institutes of Health (NIH) stroke scale score at presentation and infarct volume at 30 days were determined.

Results: Some degree of impairment in level of consciousness was observed in 409 of the 564 patients (73%). Median maximum sedation score was 2 for both right and left hemispheric stroke (p = 0.91). Mean sedation score over 24 hours was 1.5 for both right and left stroke (p = 0.75). There was no difference between level of consciousness scores in right and left stroke at any individual time point during the 24 hour monitoring period. No association between side and impairment in level of consciousness was seen after adjustment for stroke severity and infarct volume.

Conclusions: In contrast to previous reports, there was no evidence for hemispheric dominance for consciousness in the setting of a major hemispheric stroke.

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Selected References

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  1. Albert M. L., Silverberg R., Reches A., Berman M. Cerebral dominance for consciousness. Arch Neurol. 1976 Jun;33(6):453–454. doi: 10.1001/archneur.1976.00500060059013. [DOI] [PubMed] [Google Scholar]
  2. Biersack H. J., Linke D., Brassel F., Reichmann K., Kurthen M., Durwen H. F., Reuter B. M., Wappenschmidt J., Stefan H. Technetium-99m HM-PAO brain SPECT in epileptic patients before and during unilateral hemispheric anesthesia (Wada test): report of three cases. J Nucl Med. 1987 Nov;28(11):1763–1767. [PubMed] [Google Scholar]
  3. Coslett H. B., Bowers D., Heilman K. M. Reduction in cerebral activation after right hemisphere stroke. Neurology. 1987 Jun;37(6):957–962. doi: 10.1212/wnl.37.6.957. [DOI] [PubMed] [Google Scholar]
  4. Durkin M. W., Meador K. J., Nichols M. E., Lee G. P., Loring D. W. Anosognosia and the intracarotid amobarbital procedure (Wada test). Neurology. 1994 May;44(5):978–979. doi: 10.1212/wnl.44.5.978. [DOI] [PubMed] [Google Scholar]
  5. Fink John N., Selim Magdy H., Kumar Sandeep, Silver Brian, Linfante Italo, Caplan Louis R., Schlaug Gottfried. Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke? Stroke. 2002 Apr;33(4):954–958. doi: 10.1161/01.str.0000013069.24300.1d. [DOI] [PubMed] [Google Scholar]
  6. Frumkin L. R., Grim P. Is there pharmacological asymmetry in the human brain? An hypothesis for the differential hemispheric action of barbiturates. Int J Neurosci. 1981;13(4):187–197. doi: 10.3109/00207458108985801. [DOI] [PubMed] [Google Scholar]
  7. Gilmore R. L., Heilman K. M., Schmidt R. P., Fennell E. M., Quisling R. Anosognosia during Wada testing. Neurology. 1992 Apr;42(4):925–927. doi: 10.1212/wnl.42.4.925. [DOI] [PubMed] [Google Scholar]
  8. Glosser G., Cole L. C., Deutsch G. K., Donofrio N., Bagley L., Baltuch G., French J. A. Hemispheric asymmetries in arousal affect outcome of the intracarotid amobarbital test. Neurology. 1999 May 12;52(8):1583–1590. doi: 10.1212/wnl.52.8.1583. [DOI] [PubMed] [Google Scholar]
  9. Heilman K. M., Schwartz H. D., Watson R. T. Hypoarousal in patients with the neglect syndrome and emotional indifference. Neurology. 1978 Mar;28(3):229–232. doi: 10.1212/wnl.28.3.229. [DOI] [PubMed] [Google Scholar]
  10. Heilman K. M., Valenstein E., Watson R. T. Neglect and related disorders. Semin Neurol. 2000;20(4):463–470. doi: 10.1055/s-2000-13179. [DOI] [PubMed] [Google Scholar]
  11. Huh K., Meador K. J., Loring D. W., Lee G. P., Brooks B. S. Attentional mechanisms during the intracarotid amobarbital test. Neurology. 1989 Sep;39(9):1183–1186. doi: 10.1212/wnl.39.9.1183. [DOI] [PubMed] [Google Scholar]
  12. Lyden P., Brott T., Tilley B., Welch K. M., Mascha E. J., Levine S., Haley E. C., Grotta J., Marler J. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke. 1994 Nov;25(11):2220–2226. doi: 10.1161/01.str.25.11.2220. [DOI] [PubMed] [Google Scholar]
  13. Lyden P., Shuaib A., Ng K., Levin K., Atkinson R. P., Rajput A., Wechsler L., Ashwood T., Claesson L., Odergren T. Clomethiazole Acute Stroke Study in ischemic stroke (CLASS-I): final results. Stroke. 2002 Jan;33(1):122–128. doi: 10.1161/hs0102.101478. [DOI] [PubMed] [Google Scholar]
  14. McMackin D., Jones-Gotman M., Dubeau F., Gotman J., Lukban A., Dean G., Evans A., Lisbona R. Regional cerebral blood flow and language dominance: SPECT during intracarotid amobarbital testing. Neurology. 1998 Apr;50(4):943–950. doi: 10.1212/wnl.50.4.943. [DOI] [PubMed] [Google Scholar]
  15. Meador K. J., Loring D. W., Lee G. P., Brooks B. S., Nichols F. T., Thompson E. E., Thompson W. O., Heilman K. M. Hemisphere asymmetry for eye gaze mechanisms. Brain. 1989 Feb;112(Pt 1):103–111. doi: 10.1093/brain/112.1.103. [DOI] [PubMed] [Google Scholar]
  16. Meador K. J., Loring D. W., Lee G. P., Nichols M. E., Moore E. E., Figueroa R. E. Level of consciousness and memory during the intracarotid sodium amobarbital procedure. Brain Cogn. 1997 Mar;33(2):178–188. doi: 10.1006/brcg.1997.0891. [DOI] [PubMed] [Google Scholar]
  17. Meador K. J., Loring D. W. The Wada test: controversies, concerns, and insights. Neurology. 1999 May 12;52(8):1535–1536. doi: 10.1212/wnl.52.8.1535. [DOI] [PubMed] [Google Scholar]
  18. Perrine K., Devinsky O., Luciano D. J., Choi I. S., Nelson P. K. Correlates of arterial-filling patterns in the intracarotid amobarbital procedure. Arch Neurol. 1995 Jul;52(7):712–716. doi: 10.1001/archneur.1995.00540310086020. [DOI] [PubMed] [Google Scholar]
  19. SERAFETINIDES E. A., HOARE R. D., DRIVER M. INTRACAROTID SODIUM AMYLOBARBITONE AND CEREBRAL DOMINANCE FOR SPEECH AND CONSCIOUSNESS. Brain. 1965 Mar;88:107–130. doi: 10.1093/brain/88.1.107. [DOI] [PubMed] [Google Scholar]
  20. Schwartz B. Hemispheric dominance and consciousness. Acta Neurol Scand. 1967;43(4):513–525. doi: 10.1111/j.1600-0404.1967.tb05757.x. [DOI] [PubMed] [Google Scholar]
  21. Spiers P. A., Schomer D. L., Blume H. W., Kleefield J., O'Reilly G., Weintraub S., Osborne-Shaefer P., Mesulam M. M. Visual neglect during intracarotid amobarbital testing. Neurology. 1990 Oct;40(10):1600–1606. doi: 10.1212/wnl.40.10.1600. [DOI] [PubMed] [Google Scholar]
  22. Watson R. T., Andriola M., Heilman K. M. The electroencephalogram in neglect. J Neurol Sci. 1977 Dec;34(3):343–348. doi: 10.1016/0022-510x(77)90151-4. [DOI] [PubMed] [Google Scholar]

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