Case Report

Dashcam-captured moment of right hemispheric stroke
Haruna Miyazawa, MD, PhD, and Yasuo Terayama, MD, PhD

A bus driver presented with neurological abnormalities following a driving mishap.
He was diagnosed cardioembolic stroke. The bus was equipped with a dashboard
camera that recorded the moment when the patient suffered the stroke. We
reported the first case dashcam-captured images at the first sign of a right hemispheric stroke.
Keywords: Dashcam—Driving—Stroke—Anosognosia
© 2020 Elsevier Inc. All rights reserved.

Case report
A 68-year-old male bus driver presented with neurological abnormalities following a driving mishap. A neurological workup showed mild consciousness disturbance,
unilateral spatial neglect, anosognosia, conjugate eye
deviation to the right, and mild left hemiparesis. Diffusion-weighted MRI revealed an acute infarct in the posterior division of the right middle cerebral artery (Fig. 1).
The final diagnosis was cardioembolic stroke. The bus
was equipped with a dashboard camera that recorded the
moment when the patient suffered the stroke. The patient
started driving calmly and paid attention when turning
left the corner as usual. Immediately following stroke, the
patient could be seen struggling looking for his left chest
pocket to put the ballpoint pen by his right hand and left
facial paralysis in his up image. He looked like to forget
the existence of his own left arm. He was displaying
uncontrolled and dangerous driving without usual attention. Although his left arm worked when handling the
steering wheel, the mirror on the left of the bus bumped
into the wall. He lost his attention to the left side and his
face turned right all the way. The bus almost hit a pedestrian (Video). These mean left spatial neglect and anosognosia. Following successful treatment, the patient was
discharged; thereafter, he decided to retire.
From the Division of Neurology and Gerontology, Department of
Internal Medicine, School of Medicine, Iwate Medical University, 2-11 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan.
Received April 7, 2020; revision received June 21, 2020; accepted
June 23, 2020.
Corresponding author. E-mail: miyaharu@iwate-med.ac.jp.
1052-3057/$ - see front matter
© 2020 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105094

Cases of a right hemispheric brain injury, accompanied
by anosognosia, can induce problematic driving. Also,
this record supported a report that after a stroke, patients
have difficulty with speed maintenance.1
Recently, driving ability post-stroke has received considerable attention.2,3 Dashcams can capture the realworld driving behavior following a focal brain lesion,4
but catching the moment of stroke onset by dashcam has
not been previously reported. This is the first case to
report dashcam-captured images at the first sign of a right
hemispheric stroke. In this case, dashcam recordings provided evidence to convince the patient that his driving
behavior had become dangerous. In recent years, the
immediate initiation of therapeutic intervention during

Fig. 1. Diffusion-weighted imaging showed an acute infarct in the posterior
division of the right middle cerebral artery (arrow).

Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 9 (September), 2020: 105094

1

H. MIYAZAWA AND Y. TERAYAMA

2

the acute phase of a stroke has received additional emphasis. Identifying the exact onset time and symptomatic
severities is extremely important. The popularization of
video devices that can capture symptoms just after the
onset of a stroke may contribute to the future development of the diagnosis and treatment of stroke.
Video. The onset of right hemispheric stroke.
Dashcam imaging revealed that the patient drove normally before onset. Just after the stroke, he struggled to
explore the pocket on his left chest, then hit the left side of
a car and narrowly missed a pedestrian.

Declaration of Competing Interest
None.

Informed consent and patient details: Appropriate consents and permissions were obtained from our patient. Written consent is retained by the author. We thank the patient
for granting permission to publish this information.

Supplementary materials
Supplementary material associated with this article can
be found in the online version at doi:10.1016/j.jstrokecere
brovasdis.2020.105094.

References
1. Hird MA, Vesely KA, Tasneem T, Saposnik G, Macdonald
RL, Schweizer TA. A Case-Control Study Investigating Simulated Driving Errors in Ischemic Stroke and Subarachnoid
Hemorrhage. Front Neurol 2018;13(9):54. https://doi.org/
10.3389/fneur.2018.00054.
2. Park MO. A comparison of driving errors in patients with
left or right hemispheric lesions after stroke. J Phys Ther Sci
2015;27(11):3469-3471. https://doi.org/10.1589/jpts.27.3469.
3. Park MO, Jung BK. Effect of activities of daily living status
on resuming driving after stroke. J Phys Ther Sci 2015;27
(12):3759-3761. https://doi.org/10.1589/jpts.27.3759.
4. Thompson K, Read K, Anderson S, Rizzo M. Systemic
analysis of real-world driving behavior following focal
brain lesions. Proc Int Driv Symp Hum Factors Driv
Assess Train Veh Des 2011;2011:576-582.