Abstract
Introduction: Right Hemisphere Strokes (RHS) are characterized by severe motor and sensory deficits and signs of neglect including extinction and inattention. National Institutes of Health Stroke Scale (NIHSS) score provides an objective measurement of presence or absence of neglect. Data regarding the impact of neglect on outcomes after RHS thrombectomy are lacking. We hypothesize that the presence of neglect in RHS is associated with worse outcomes after thrombectomy in RHS. Methods: Retrospective analysis of prospectively collected database of right sided anterior circulation large vessel occlusion [internal carotid and/or middle cerebral artery M1] strokes at a comprehensive stroke center. Patients with successful recanalization (TICI≥ 2B) and complete follow-up data were included in the study. Two group of RHS were identified- with and without neglect by itemized NIHSS. Baseline characteristics and outcomes were compared. Results: A total of 172 patients were included in the study. Median NIHSS score was 15 (11-18) and median ASPECTS was 9 (8-10). Signs of neglect were observed in 63% (108) of patients. In multivariate analyses, younger age [0.9 (0.8-0.95) p=<0.01] and higher ASPECTS [1.8 (1.1-3.1) p=0.015] were independent predictors of mRS 0-2 at 90 days. Absence of neglect [0.39 (0.13-1.1) p=0.07] may predict good outcome. Independent predictors of mortality on multivariate analyses included older age [1.1 (1.03-1.15) p =0.001], presence of atrial fibrillation [0.3 (0.1-1) p=0.05] and diabetes mellitus [0.16 (0.05-0.53) p=0.003]. Presence of neglect [2.5 (0.9-6.6) p=0.06] and lower ASPECTS [0.7 (0.4-1) p=0.06] may predict mortality. Conclusion: Signs of neglect were observed in approximately 63% of right hemisphere LVO strokes. Presence of neglect may predict poor functional outcome and mortality at 90 days after thrombectomy for right hemisphere strokes. Further studies are required to evaluate the impact of thrombectomy on recovery of neglect.
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