Manifestations of Right- and Left-brain Stroke – Stroke Nursing Care in ER

by Rhonda Lawes

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    00:01 Now, I've got a question for you. So this is the chance where you get to decide what you think you should do in this question. Okay. So, because of the assessment data, so you may have to pause the video and go back and look at your notes. That's fine. That's what we want you to do. But because of the assessment data, you suspect that Mr. Johnson has had a stroke or a TIA.

    00:22 Which side of the brain is most likely to be the site of injury for Mr. Johnson? Okay. So, now you've got to think back into what you know about the brain and how it controls the body. So, pause the video for just a minute.

    00:35 Please don't peek. See if you can recall what you think which side of the brain is most likely to be the site of injury for Mr. Johnson? Okay. The answer is, the left side of the brain is the most likely site of injury because he has right-sided weakness and difficulty with speech. Those are classic signs of a left-sided stroke.

    01:04 Now let's look at the difference between a right-brain and a left-brain stroke.

    01:09 See, the patient has a stroke on the right side. He's paralyzed on the left side.

    01:13 Now we call that hemiplegia, right? Hemiplegia or normal people would just say hemiplegia. But it means – "hemi" means half, "plegia" means the paralysis. So, a stroke on the right side causes paralysis on the left side.

    01:32 Injury here, paralysis on this side.

    01:36 They can also do -- some of them do a left-sided neglect.

    01:39 Now, I've seen some patients that were so severe when they -- they were male patients when they would shave, they only wanted to shave the right side of their face. It was almost as if the left side didn't exist. It's really just a bizarre thing that a brain does after a stroke, sometimes.

    01:55 They have some very spatial-perceptual deficits, so that can make things like stairs or distances really difficult for patients.

    02:03 They might tend to deny or minimize problems. "I'm fine, I'm okay. It's not a big deal." So, that's pretty common with someone who has a right-sided stroke.

    02:12 They might have some performance issues. They have a really short attention span.

    02:16 They can be very impulsive, so this makes some safety issues. These are the people, as they're recovering, are likely to jump out of bed when they don't have the ability to be safe. So their judgment and concept of time can be way, way off.

    02:32 These are all very common manifestations that you'll see from a stroke on the right side, causes problem on the left side, but also causes some unusual things like that spatial perceptual problem.

    02:45 Now let's look at a stroke on the left side. That means the injury is on this side of the brain. The paralysis or hemiplegia is on the right side of the brain. They have difficulty with speech.

    02:58 Okay, and they have a hard time with right and left discrimination. They're very slow in performing things and tasks and following commands. They're very cautious. They're very aware of their deficits. This side is most often likely to develop depression and have anxiety.

    03:16 And they have a difficult time with comprehension related to language and particularly math, which, some days, I swear I've had a left-sided stroke, because I always have a hard time with math. Long list. What's the best thing to do with a long list? Well, we put both of these on one slide. Because if you look at these, look at the things that are vastly different, right? Right-sided stroke is impulsive.

    03:43 A left-sided stroke is cautious and slow.

    03:47 So spend some time with this slide. Compare the things that could be similar and things that are very, very different.

    03:54 Pause the video, spend some time chunking information, grouping things together, and deciding how your brain best works to remember them.

    04:06 Okay. So, let's talk a little bit about why. Now, you see we've got a picture there for you. It's the right side of the brain, the left side of the brain. And we're going to talk about contralateral control. See, neurons in the cerebral cortex control movements of the contralateral or opposite side limb. So, injury on the right side gives me problems on the left, because the right side controls my left. Injury on the left side, it's -- that's the one that controls my right. The answer is contralateral control.

    04:39 Now, the pyramidal pathways crosses at the level of the medulla. So look right there. They did a beautiful job for you. Look, the medulla you've got that lateral corticospinal tract and those were the fibers crossover. So, the gray part of the drawing is showing you that you've got the brain and the spinal cord, but we've got the medulla, right there, and that's where the crossover happens. Okay. So, that's where you end up with the right side controlling the left, and the left side controlling the right.

    05:10 Injury on one side of the brain affects that motor function because of this crossover, right there at the medulla. So that's what was called contralateral control.

    About the Lecture

    The lecture Manifestations of Right- and Left-brain Stroke – Stroke Nursing Care in ER by Rhonda Lawes is from the course Neurology Case Study: Nursing Care of Stroke Patient.

    Included Quiz Questions

    1. Impaired speech/language aphasias
    2. Slow performance and cautious actions
    3. Depression and anxiety
    4. Left-sided neglect
    5. Impaired judgment and time concepts
    1. Left-sided neglect
    2. Spatial-perceptual deficits
    3. Rapid performance and short attention span
    4. Impaired comprehension related to language and math
    5. Impaired right/left discrimination

    Author of lecture Manifestations of Right- and Left-brain Stroke – Stroke Nursing Care in ER

     Rhonda Lawes

    Rhonda Lawes

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