Right-Sided Strokes: What to Expect

Strokes are defined as right-sided or left-sided based on which hemisphere (side) of the brain is affected. Since different regions of the brain control specific functions, the effects of a stroke correlate to the damaged area of the brain.

A right-sided stroke can cause many symptoms. The most noticeable are those that affect the left side of the body, which is controlled by the right side of the brain.

This article will discuss the types of right-sided strokes, signs, effects, treatment, and prevention.

Types of Right Hemisphere Strokes 

Any stroke, including a right-sided stroke, can occur due to either a blood clot, bleeding, or both. 

Ischemic

An ischemic stroke is caused by a decrease in blood flow to an area of the brain. Even a few minutes of inadequate blood flow can cause damage to the brain tissue. 

An ischemic stroke can be caused by a blood clot in a large blood vessel or a small blood vessel. Usually, blockage of blood flow in a small vessel causes less damage than blockage of blood flow in a larger vessel. 

Often, small vessel strokes occur due to atherosclerosis of an artery in the brain. Atherosclerosis is a combination of blood vessel damage and a buildup of material that can eventually lead to complete blockage of blood flow.

Sometimes strokes are caused by a blood clot that traveled from the heart or the carotid artery to the brain. This is more common with large vessel strokes. 

Hemorrhagic 

A hemorrhagic stroke occurs when a blood vessel leaks into the brain. Blood causes harmful irritation to the brain tissue, and the bleeding also deprives the nearby area of the brain of adequate blood supply. 

Signs 

A right-sided stroke can occur suddenly, and it can cause: 

• Sudden weakness of the face, arm, or leg
• Severe dizziness, balance problems, and difficulty walking 
• Confusion 
• Head pain, especially from a hemorrhagic stroke 

Sometimes a stroke can evolve rapidly, and the symptoms can seem confusing and overwhelming. If you or someone else experiences any of these signs, get medical attention immediately. 

Effects 

The specific effects that you experience from a right-sided stroke can become more obvious to you as you become more medically stable in the days after the initial event. Effects can persist for years, and sometimes the effects can improve over time.

A right-sided stroke causes immediate and lasting effects that differ from those of a left-sided stroke. 

Hemiplegia on the Left Side

Hemiplegia is paralysis (complete loss of movement) on one side of the body. A right-sided stroke can cause hemiplegia of the whole left side of the body.

More commonly, this type of stroke causes left-side hemiparesis, which is diminished strength, without total paralysis. It usually affects only the face, arm, or leg—not necessarily the whole left side.

Sometimes, months or years after the stroke, spasticity (muscle stiffness or rigidity) can develop in the weak muscles. This occurs when a stroke affects the right motor strip of the cerebral cortex (which helps control movement) or the right internal capsule (nerve fibers from the motor strip run through this area).

Diminished Sensation on the Left Side 

After a right-sided stroke, it is possible to have diminished sensation or loss of sensation on the left side of the body. Sometimes paresthesias (numbness, tingling, or other unusual sensations) or pain can develop in the areas of the body that have diminished sensation. This usually begins after weeks, months, or longer. 

Sensory disturbances on the left side of the body can occur due to a stroke in the right sensory strip of the cerebral cortex or the right thalamus. 

Prosopagnosia

One of the rare effects of a right-sided stroke is prosopagnosia, which is an inability to recognize faces. This can occur due to a stroke affecting the right fusiform gyrus, an area near the back of the brain that works to help identify faces.

Left Neglect

One of the distressing characteristics of a right-sided stroke is deceased attention to the left side of the body or an inability to recognize the area of the body impacted by the stroke. As with other effects of a right-sided stroke, the severity of this problem can range from mild to severe.  

Neglect can occur when a stroke affects the right parietal lobe (a back part of the brain). 

Homonymous Hemianopia

A right-sided stroke can cause loss of vision on the left side from both eyes. This can affect the whole left side, or only the upper or lower part of vision on the left side. This is called left homonymous hemianopia.

A stroke affecting the right occipital lobe, which is the farthest back region of the brain, can cause left homonymous hemianopia. 

Anosognosia

This complex effect is the inability of a person to recognize that they have a disability from a stroke. It is similar to neglect, but there are some subtle distinctions because a person who is experiencing anosognosia may recognize the impaired area of the body, but can be unable to recognize the impairment. 

Anosognosia can occur due to damage in the right parietal, temporal, or frontal lobe of the brain. 

Pseudobulbar Affect 

This condition can occur due to a number of different neurological conditions, including a right-sided stroke. The symptoms of pseudobulbar affect include episodes of uncontrollable emotional outbursts, such as laughing or crying. They may be inappropriate, as the emotions come out at random times and don't always make sense.

It can be embarrassing for some people who may be distressed by their own lack of emotional control. People who have had a very large stroke might not notice the effects or might not be distressed about it. 

Treatment 

There are several treatments for a stroke. When the symptoms first begin, treatment can include blood pressure control, fluid management, and sometimes blood thinners. These interventions can reduce the damage of a stroke and improve survival. 

After the acute stage of a right-sided stroke, treatment involves rehabilitation. This can include physical therapy, speech and swallow therapy, cognitive therapy, and occupational therapy to help maximize movement and self-care. 

Prevention 

After a stroke, prevention of further strokes is important. Diagnostic testing involves tests that assess stroke risk factors. Prevention is focused on managing risk factors to reduce the chances of another stroke. 

Prevention includes:

• Maintaining optimal blood pressure 
• Diet modification and medical treatment to achieve healthy cholesterol and triglyceride levels 
• Control of diabetes 
• Blood thinners if there is a high risk of blood clots
• Treatment of heart problems, such as valve disease, coronary artery disease, and irregular heart rhythms 
• Smoking cessation

Prevention involves consistent surveillance of risk factors and assessment of risk factor control. 

Summary

A stroke can have many different effects, depending on which side of the brain is affected. A right-sided stroke can cause left-sided weakness, left-sided sensory loss, loss of vision from the left side of both eyes, personality changes, neglect of the left side of the body, and lack of recognition of the stroke.

The risk of having a stroke can be reduced if risk factors are identified and managed. Often, a stroke can be treated, but there can be residual effects. The larger a stroke, the more substantial the effects. Stroke rehabilitation is an important part of recovery.