Hemi-Inattention

Many medics do not realize that the Cincinnati Stroke Scale or Los Angeles Prehospital Stroke Screen are only reliable at identifying a hemispheric stroke. They can usually identify paralysis or weakness on one side of the body or another, but aren’t really geared towards identifying stroke of the brainstem, cerebellum, or intracranial hemorrhage.

To do that, you have to check for limb ataxia, visual field deficits, and deficits in extraocular movements.

But one phenomenon that never ceases to amaze me is non-dominant hemisphere syndrome. For around 85% of the population, the left hemisphere of your brain is the dominant one. Southpaws have a dominant right hemisphere.

And when a right-hander strokes out the right, non-dominant hemisphere of their brain, often the left-sided paralysis is accompanied by a total lack of awareness that anything is wrong.

Weird, that.

I’ve had a couple of patients over the years that I had to force to go to the hospital, so deep was their denial. One sweet little old lady was so certain that nothing was wrong with her that she insisted that the frail, flaccid black arm I was holding up before her eyes was my arm.

The guy I ran just a little while ago wasn’t quite that bad, but it still never fails to weird me out when I have to point out to someone that one entire side of their body has stopped working.