Abstract
Objective: To determine if the side of an ischemic stroke (IS) is associated with the rate of intracerebral hemorrhage (ICH), hypothesizing that right-sided IS may cause agnosia and consequently inaccuracies in reporting last known normal times, leading to higher rates of ICH.
Background: Studies have found that patients with right-side IS present to the ED later, are less likely to receive IV-tPA, and have worse outcomes than patients with left-side IS.
Design/Methods: We performed a retrospective, matched, case-control study of adult IS patients treated with IV-tPA at a Comprehensive Stroke Center (1/2016–9/2016). Patients who developed ICH (asymptomatic or symptomatic; cases) were individually matched to those without ICH (controls) 1:1 on age (±10yrs), stroke severity (NIHSS, ±5 points), and time to IV-tPA (±30 min). We examined differences between the cases and controls univariately and assessed the paired relationship between the side of IS and ICH with McNemar’s test.
Results: Of 191 IS patients who received IV-tPA, 45 (24%) developed an ICH. After excluding basilar/bilateral strokes (n=2) and ICH patients unable to be matched (n=13), there were 30 cases and 30 controls well matched for age, NIHSS, time to IV-tPA, and other covariates. Of the 30 ICHs, 27 (90%) were asymptomatic; 3 (10%) were symptomatic. A larger percentage of patients with ICH received intra-arterial therapy compared to patients without ICH (60% vs 37%, p=0.07). Strokes were left-sided in 57% of cases and 60% of controls (p=0.79). No significant relationship was found between the paired data; among cases and controls, there were 17 pairs with concordant stroke sides and 13 discordant pairs (7 right-left and 6 left-right, respectively) (p=0.78).
Conclusions: In patients who received IV-tPA, ICH was not more likely to occur in patients with a right-side, compared to a left-side IS, after controlling for age, severity, and time to tPA.
Disclosure: Dr. Bartt has nothing to disclose. Dr. Leonard has nothing to disclose. Dr. Salottolo has nothing to disclose. Dr. Nieberlein has nothing to disclose. Dr. Bar-Or has nothing to disclose.
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