Hemispheric Lesion Laterality and Cognitive Impairment in Acute Stroke: A Narrative Review
- Medical Education Study Program, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
- Departement of Neurology, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
First published: 11 November 2026
Abstract
Introduction: Cognitive impairment is a frequent and early consequence of acute stroke, affecting more than 70% of patients in the first weeks after onset. Because the cerebral hemispheres are functionally lateralized, the hemisphere affected by stroke may shape both the severity and the profile of cognitive deficits. This review summarizes current evidence on the relationship between hemispheric lesion location and cognitive impairment in the acute phase of stroke.
Methods: A narrative review was conducted of literature published between 2014 and 2025 in PubMed/MEDLINE, Google Scholar, and the Garuda portal, focusing on post-stroke cognitive impairment and lesion location.
Results: Post-stroke cognitive impairment arises from ischemic injury, neuroinflammation, oxidative stress, white matter disruption, and neurotransmitter imbalance. Left hemisphere lesions are more consistently associated with impairment of language, verbal memory, abstraction, and executive function, and with more severe global impairment. Right hemisphere lesions predominantly affect visuospatial abilities and emotional and social cognition, frequently with neglect and anosognosia that hinder rehabilitation. Lesion–symptom mapping studies indicate that strategic infarct location, rather than hemispheric side alone, determines cognitive outcome, with key regions in the left angular gyrus, left basal ganglia, left thalamus, left frontotemporal cortex, and right parietal lobe.
Conclusion: Hemispheric lesion location provides clinically useful information on the expected pattern of cognitive impairment after acute stroke, but it should be interpreted together with lesion volume, strategic location, and vascular burden. Early, domain-specific cognitive assessment adapted to the side of the lesion can support prognostication and individualized rehabilitation.
Keywords: Acute Stroke, Cerebral Hemispheres, Lateralization, Lesion–Symptom Mapping, Post-Stroke Cognitive Impairment, Vascular Cognitive Impairment
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