Neuropsychological deficits in patients with favorable outcomes after middle cerebral artery infarction treated with thrombectomy

Introduction: Functional outcomes following stroke thrombectomy are commonly measured by the modified Rankin Scale (mRS). Due to hemisphere-specific representation of neuropsychological function, the mRS might underestimate persisting functional deficits, particularly in large right-hemispheric strokes. This study aimed to assess infarct volumes and neuropsychological symptoms in patients with left- and right-sided middle cerebral artery (MCA) infarctions treated with thrombectomy, having a favorable outcome at 3 months. We hypothesized that patients with right-sided strokes are affected by larger infarct volumes and suffer from neuropsychological and cognitive impairment despite being classified as functionally recovered on the mRS. Methods: The study cohort consisted of 105 patients with MCA infarctions treated with thrombectomy and a favorable outcome at 3 months after stroke according to mRS 0-1. The infarct volumes after thrombectomy were measured using imaging data. Consenting patients received follow-up examinations through telephone interviews and written questionnaires (Stroke Impact Scale-16, Short Form-36). Patients with the largest infarct volumes were additionally assessed with a neuropsychological test battery (Test of Attentional Performance - Mobility-Version, TAP-M) and the Montreal Cognitive Assessment. Results: < 0.05). Compared to age-dependent standard values, patients with right-sided MCA infarctions showed longer reaction times, impaired divided attention, and subclinical neglect to the left. Additionally, the majority of these patients showed mild cognitive impairment. Discussion and conclusion: These findings indicate that patients with right MCA infarctions, being categorized as having a "favorable functional outcome" on the mRS, suffer from relevant neuropsychological deficits, subclinical neglect, and reduced quality of life.