From the Guidelines
A right fronto-parietal infarct typically causes left-sided weakness or paralysis, sensory deficits, speech and language problems, cognitive impairments, neglect syndrome, and visual field defects due to damage to the motor cortex, parietal lobe, and other areas. The symptoms of a right fronto-parietal infarct can vary depending on the size and location of the infarct, but generally include left-sided hemiparesis or hemiplegia, numbness or altered sensation, and speech and language problems if the infarct extends to language areas 1.
Common Symptoms
- Left-sided weakness or paralysis (hemiparesis or hemiplegia) affecting the face, arm, and leg
- Sensory deficits on the left side of the body, including numbness or altered sensation
- Speech and language problems, particularly if the infarct extends to language areas
- Cognitive impairments, such as difficulty with attention, concentration, planning, and problem-solving
- Neglect syndrome, where the patient ignores or is unaware of the left side of their body or environment
- Visual field defects, like left homonymous hemianopia (loss of vision in the left half of both eyes)
Management and Treatment
The management of a right fronto-parietal infarct typically involves preventing further deterioration from tissue displacement and brain stem shift, and correcting factors that could exacerbate swelling, such as hypoxemia, hypercarbia, and hyperthermia 1. The head of the bed can be elevated at 20° to 30° to help venous drainage, and antihypertensive agents that include cerebral vasodilatation should be avoided. In some cases, decompressive surgery may be necessary to remove necrotic tissue and relieve pressure on the brain.
Prognosis and Outcome
The prognosis and outcome of a right fronto-parietal infarct depend on the size and location of the infarct, as well as the patient's overall health and response to treatment. Patients with larger infarcts or those who experience significant brain swelling may have a poorer prognosis and be at higher risk for complications, such as brain herniation and death 1. Early recognition and treatment of the infarct, as well as aggressive management of any complications that arise, can help improve outcomes and reduce the risk of long-term disability.
From the Research
Right Fronto Parietal Infarct Symptoms
- The arm levitation sign is a neurological sign that can be observed in patients with acute right fronto-parietal stroke 2.
- This sign is characterized by the patient's arm levitating or drifting upwards, and it is thought to be caused by damage to the motor control systems in the brain.
- The imaging correlates of this sign include damage to the frontal and parietal lobes, which are responsible for motor control and spatial awareness.
- Patients with right fronto-parietal infarcts may also experience other symptoms such as weakness, numbness, or paralysis of the face, arm, or leg, as well as difficulties with speech, vision, or cognition.
Treatment and Management
- Combination antiplatelet therapy with clopidogrel and aspirin may be used to reduce the risk of recurrent stroke in patients with minor ischemic stroke or high-risk transient ischemic attack (TIA) 3, 4.
- However, this treatment may also increase the risk of major hemorrhage, and the benefits and risks should be carefully weighed for each individual patient.
- Clopidogrel monotherapy may be associated with a lower risk of bleeding compared to aspirin monotherapy, and may be a suitable alternative for secondary prevention in patients with recent ischemic stroke 5.
- The choice of treatment should be based on the individual patient's risk factors, medical history, and clinical presentation, and should be guided by the latest clinical guidelines and evidence-based recommendations.
Rehabilitation and Recovery
- Patients with right fronto-parietal infarcts may require rehabilitation to regain strength, mobility, and cognitive function.
- Rehabilitation programs may include physical therapy, occupational therapy, speech therapy, and cognitive therapy, and should be tailored to the individual patient's needs and goals.
- The presence of the arm levitation sign may indicate a higher risk of rehabilitation problems, and patients with this sign may require more intensive or specialized rehabilitation programs 2.