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PubMed1987

Rotation of the scapula and shoulder subluxation in hemiplegia.

Inferior subluxation of the shoulder in hemiplegia was measured using a tridimensional (3-D) x-ray technique. This technique gave the true vertical distance separating the apex of the humeral head and the inferior margin of the glenoid cavity. Both shoulders of each subject were evaluated and the difference used as a measure of subluxation. This measure was then compared to the orientation of the scapula relative to the vertical, to the abduction, and to the relative abduction of the arm. Relative abduction is defined as the angle between the humerus and the glenoid fossa. It has been suggested that these factors are associated with inferior subluxation in hemiplegia. Results of this study of 50 volunteer stroke patients indicated that the affected and nonaffected shoulders were different (subluxed) in terms of the vertical position of the humerus vis-à-vis the scapula. The orientation of the glenoid cavities was also different, the subluxed one facing less downward. The angle of abduction of the arm of the affected side was significantly greater than on the nonaffected side, but the relative abduction of the arm was on the same order of magnitude for both sides. There was no significant relationship between the orientation of the scapula and the severity of the subluxation. The abduction of the humerus was weakly (r = .24) related to the subluxation, which partly explained the weak association found between the relative abduction of the arm and the subluxation. It was concluded that the position of the scapula and the relative abduction of the arm cannot be considered important factors in the occurrence of inferior subluxation in hemiplegia.

Female↗
PubMed1986

Shoulder pain in hemiplegia: statistical relationship with five variables.

The incidence of shoulder pain and the statistical relationship between it and five other variables (patient age, time since onset of hemiplegia, range of hemiplegic shoulder external rotation, spasticity and weakness) were investigated retrospectively. Of 50 consecutive hemiplegic patients whose records were reviewed, 36 had shoulder pain. The variables significantly (p less than 0.01) correlated with shoulder pain were: time since onset of hemiplegia (r = 0.45) and ROSER (r = -0.61). The relationship between shoulder pain and range of shoulder motion remained significant when other factors were partialled out. The relationship between shoulder pain and time since onset was not significant when the affect of range of shoulder motion was partialled out. Therefore, range of shoulder external rotation was considered the factor related most significantly to shoulder pain. This finding suggests that shoulder pain demonstrated by hemiplegia patients may be, in part, a manifestation of adhesive capsulitis.

Adult↗
PubMed1986

Painful shoulder in hemiplegia.

Shoulder pain is probably the most frequent complication of hemiplegia. In this study 219 hemiplegia patients were regularly followed up after their cerebrovascular accident (CVA) for one year (166 men, 53 women, with a mean age of 47 years). Criteria and parameters for evaluation of these shoulders were established at the outset. Distinction was made between flaccid and spastic hemiplegia. Other influencing factors were subluxation reflex sympathetic dystrophy syndrome (RSD), isolated tendon lesion cuff rotator tear or association of some of these. Roentgen examinations were done for each patient. In our series of patients, 72% had shoulder pain at least once during the course of their recovery. This problem occurred more often in patients having spasticity (85%) than in those with flaccidity (18%). An evolution towards spasticity was noted in 80% of the patients in this series, whereas 20% remained hypotonic. Among the other possible causes of shoulder pain, anteroinferior subluxation was incontrovertibly the most frequently cited. The RSD syndrome was present in only 23% of all cases but was seen more often in spastic patients, that is 27% compared to 7% among flaccid patients. Whatever the cause, the subluxation with flaccid paralysis should be corrected and spasticity should be combatted as early and as vigorously as possible.

Adolescent↗
PubMed1983

[Acute hemiplegia due to cerebral artery occlusion in children. Apropos of 9 cases].

The cerebral arterial occlusion was observed from nine patients aged from 2,5 to 12 years old, between 37 children with acute acquired hemiplegia. The thrombosis had an embolic origin in three cases of cardiopathy. Six patients had primary arterial occlusion, but all these patients were febrile and the onset of hemiplegia was accompanied by seizures in five cases. The site of arterial was demonstrated by the angiography in eight cases: cervical internal carotide in one case of cardiomyopathy, intracranial portion of the internal carotide in four cases, middle and anterior cerebral artery in three cases. The regression of hemiplegia was observed in all but one case of atrial myxoma. The autopsy of this patient revealed renal and hemispheric cerebral arterial thrombosis with myxoma embolus.

Acute Disease↗
PubMed1993

[A case of cough hemiplegia].

We reported a patient with internal carotid artery occlusion (ICAO) who developed cough-induced transient hemiplegia. A 63-year-old man with chronic obstructive pulmonary disease experienced several episodes of cough-induced left hemiplegia during drinking and smoking. Selective cerebral angiography demonstrated right ICAO at the vessel origin, with 50% stenosis of the left internal carotid artery. Collateral circulation from the right external to internal carotid artery branches and through the anterior communicating artery was poorly observed on the angiograms. Right middle cerebral artery branches were well visualized on vertebral angiograms at the late phase through the posterior and anterior pericallosal arteries. Due to this collateral blood supply, the right middle cerebral artery territory formed the most distal part of the cerebral circulation and was vulnerable to a reduction of cerebral blood flow. We considered that systemic hemodynamic disturbances by identical mechanisms to those observed in cough syncope may have brought about transient ischemia in the right middle cerebral artery territory which was manifested in the patient's unusual clinical presentation of ICAO "cough hemiplegia".

Carotid Artery, Internal↗
PubMed1994

[Brain perfusion in acute infantile hemiplegia studied with single photon emission computed tomography].

Sequential examinations of single photon emission computed tomography (SPECT) were performed on a 5-month-old boy with acute infantile hemiplegia from the acute ictal stage. SPECT was performed with technetium-99m-hexamethyl-propylene-amineoxime during the status when the patient had left-hemiconvulsions (status epilepticus) and on the 3rd, 7th and 10th day after the status. During the ictal stage and the 3rd day after the status, diffuse hyperperfusion was revealed in the right hemisphere, while diffuse hypoperfusion was exhibited in the right hemisphere on the 7th and 10th day after the status. Hypoperfusion in the corresponding hemisphere, after the status, has been reported in patients with acute infantile hemiplegia. There has, however, been no report of ictal brain perfusion. The pathogenesis of this hyperperfusion is not clear, but alteration of brain perfusion in this patient, especially in acute phase, may help to elucidate the etiology of acute infantile hemiplegia.

Brain↗
PubMed1996

Test-retest reliability of the Chattecx Balance System in the patient with hemiplegia.

The purpose of this study was to determine the test-retest reliability of the Chattecx Balance System in the patient with hemiplegia. Twenty patients (14 male, 6 female; 14 right hemiplegia, 6 left; mean age 69.5, range 32-86 years) undergoing physical therapy, were tested on the Chattecx Balance System at the same time on 3 consecutive days. Subjects were tested on a static platform, and also using linear translation (anterior-posterior movements), and rotational angular motion about a mediolateral axis. Day 1 was used to allow the patient to become familiar with the testing equipment and the protocol. Data collected from days 2 and 3 were compared statistically using Intraclass Correlation Coefficient (ICC) formula 3,1. Comparison of the center of pressure in the mediolateral direction (COBX), the center of pressure in the anteroposterior direction (COBY), and dispersion index were analyzed for each of the three protocols. ICCs ranged from 0.58 to 0.92 for the static platform, 0.46 to 0.83 for the linear translations, and 0.62 to 0.89 for the angular rotations. Results using this testing protocol showed COBX to be highly reliable for the static and moderately reliable for linear and angular testing protocols. COBY was not reliable for any test condition. Dispersion was moderately reliable only for the static and angular testing protocols. From a clinical standpoint, measures that were found to be highly or moderately reliable may be useful for demonstrating the progress of patients with hemiplegia in their rehabilitation programs.

Adult↗
PubMed1997

[A case report of alternating abducens hemiplegia with special reference to the supranuclear pathway to the facial nucleus].

A case of alternating abducens hemiplegia was reported. A 16-year-old girl developed alternating hemiplegia characterized by the left abducens nerve palsy and right hemiparesis. In addition, she had right supranuclear facial nerve palsy. A brain MRI showed left mid to lower pontine lesion and vertebral angiography revealed medullary venous malformation in the left pons. SEP with right posterior tibial nerve stimulation showed a delayed central conduction time, suggesting that the lesion involved left medial lemniscus. We previously reported a 39-year-old man who developed pure alternating abducens hemiplegia. He did not show supranuclear facial nerve palsy or SEP abnormality. These findings support the idea that the supranuclear facial nerve fiber leaves the pyramidal tract at the upper to middle pons and descends in the area of the pontine tegmentum around the medial lemniscus.

Abducens Nerve↗
PubMed1998

The longitudinal stability of psychiatric problems in children with hemiplegia.

A representative sample of 328 children with hemiplegia was assessed by behavioural screening questionnaires completed by parents and teachers; just under half were also individually assessed. Four years later, 90% of the sample were followed up by questionnaire. There was substantial continuity across time for most measures of psychopathology. Depending on the measures used, around 70% of children who were psychiatric "cases" initially were still cases 4 years later. In addition, around 30% of children who were not psychiatric cases initially had become cases 4 years later. In the pre-school years, externalising symptoms were predictive of later conduct and hyperactivity problems, whereas emotional symptoms were not predictive of later problems. In the school years, hyperactivity was particularly predictive of continuing psychiatric problems. Neurological, cognitive, demographic, and family factors did not add much predictive power once allowance had been made for the severity and type of the initial psychiatric problems. Since the psychiatric complications of childhood hemiplegia are persistent as well as common, they warrant increased clinical and research attention. All children with hemiplegia deserve careful monitoring for psychiatric problems, with a view to early intervention or the deployment of preventative approaches.

Child↗
PubMed1997

[Left temporal meningioma disclosed by ipsilateral hemiplegia].

A 46 year-old woman presented with a weakness of the left side. MRI of the brain showed a left temporal meningioma, a left temporal lobe herniation and two high-signals in the right cerebral peduncle. The involvement of the pyramidal tract in the foot of the cerebral peduncle, in this case, results from temporal lobe hemiation. These findings are different from the mechanisms reported in other cases of ipsilateral hemiplegia. The ipsilateral hemiplegia syndrome was classically described by Ectors in relation to a meningioma of the foot of the third frontal circonvolution. Pathophysiological theories of ipsilateral hemiplegia are reviewed.

Brain Neoplasms↗
PubMed2000

Hyperkinesia contralateral to acute hemiplegia: relevance of previous frontal lesions.

Two patients with a hyperkinetic syndrome contralateral to acute hemiplegia are presented. One patient showed a right-sided hemiplegia associated with abnormal movements of the left upper limb. In the other patient hemiplegia was localised on the left side while abnormal movements involved the right lower limb. Brain imaging showed acute infarctions (respectively left middle cerebral artery area and right lacunar infarctions) associated with a pre-existing contralateral infarction involving anterior non-primary motor areas. Hyperkinetic syndromes in stroke are mainly related to acute lesion of the contralateral subcortical areas. In our patients, the acute lesions were located ipsilateral to the hyperkinetic body part while the pre-existing lesions were located contralateral to the hyperkinetic side. We speculated that these pre-existing lesions might play a role in the pathophysiology of this clinical syndrome.

Journal Article↗
PubMed2002

Caesarean section under general anaesthetic in a woman with alternating hemiplegia of childhood.

Alternating hemiplegia of childhood is a rare progressive disorder usually diagnosed in early childhood. It consists of repeated attacks of dystonia, hemiplegia or quadriplegia followed by fixed neurological deficits and developmental delay. A case is reported of a 33-year-old woman with alternating hemiplegia of childhood who presented at 34 weeks' gestation for urgent lower segment caesarean section due to repeated antepartum haemorrhages and following failed induction of labour.

Journal Article↗
PubMed1986

Equine laryngeal hemiplegia. Part V. Central nervous system pathology.

Evidence of long central nerve fibre degeneration (axonal spheroids) in the lateral cuneate nuclei was found in all eight Thoroughbreds affected clinically and subclinically with equine laryngeal hemiplegia, but in only one of six control animals. It was considered that these spheroids may signify a central nervous component of the disease process of laryngeal hemiplegia although until further investigations are performed no firm conclusions regarding the relationship of these findings with laryngeal hemiplegia could be made. Examination of the left and right nucleus ambiguus of clinical and subclinical laryngeal hemiplegic horses revealed no pathological alterations.

Journal Article↗
PubMed2001

Characteristics of gait in hemiplegia.

The following review examines the walking patterns of patients who have hemiplegia, primarily as a result of a stroke. Attention is given to the changes in the distance and temporal factors of walking, phasic patterns and joint ranges of motion throughout the walking cycle, the ground reaction forces, joint moments of force, joint powers, energy expenditure, and muscle activation patterns. The effect of orthotic intervention on these walking parameters is also addressed. A frequently cited issue regarding the gait patterns of these patients was that their walking patterns exhibit significant deviations from normal healthy individuals. Although hemiplegia is primarily associated with unilateral motor involvement, changes in almost all of the parameters used to assess walking were evident on both the involved and uninvolved sides of the body. Last, although hemiplegia appears to reflect a single diagnostic category, there is large interindividual variability in the patterns of gait deviations, which suggests that the management and treatment of these patients need to address the unique deficits of the individual.

Journal Article↗
PubMed1987

Pure motor hemiplegia due to meningovascular neurosyphilis.

Two young male homosexuals developed prodromal syndrome followed by penicillin-responsive meningitis and the acute onset of pure motor hemiplegia. The clinical and laboratory features are consistent with meningovascular neurosyphilis. Basis pontis infarctions were subsequently demonstrated on magnetic resonance imaging scans. To our knowledge, this is the first description of syphilitic arteritis as a pathophysiologic basis for pure motor hemiplegia.

Adult↗
PubMed1977

Movement disorders as a complication of acute hemiplegia of childhood.

We evaluate three cases of acute hemiplegia in childhood complicated by tremor and/or choreoathetosis. Each patient experienced the abrupt onset of hemiplegia thought to be localized to an insult involving the middle cerebral distribution without associated seizure, trauma, loss of consciousness or demonstrable cardiac, hematological or neoplastic causes. All three patients recovered most, if not all, strength on the affected side, but each was left with a disorder of movement involving the previously hemiplegic upper extremity. These disorders included resting and intention tremors, as well as choreoathetosis. Anticholinergic drugs failed in treating two patients, but biofeedback techniques were quite successful in one of the two patients so treated.

Acute Disease↗
PubMed1987

Experimental hemiplegia in the monkey: basal ganglia glucose activity during recovery.

Unilateral ablation of cerebral cortical areas 4 and 6 of Brodmann in the macaque monkey results in a dense contralateral hemiplegia that recovers partially with time. During the phase of dense hemiplegia, the local cerebral metabolic rate for glucose (lCMRGlc) is decreased significantly in the caudate nucleus, putamen, globus pallidus, subthalamic nucleus, substantia nigra, and red nucleus of the hemisphere ipsilateral to the lesion. In the present study, lCMRGlc in the basal ganglia was studied during the phase of partial recovery of motor activity. lCMRGlc was partially restored, and the greatest degree of restoration occurred in structures with direct connections to the cerebral cortex (caudate nucleus, putamen, subthalamic nucleus, substantia nigra, and red nucleus). Restoration was least in structures that do not receive direct connections from the cerebral cortex (the internal and external segments of the globus pallidus). The findings support the hypothesis that corticofugal activity accounts for a substantial degree of functional recovery.

Animals↗
PubMed1993

Evidence for mitochondrial dysfunction in patients with alternating hemiplegia of childhood.

Phosphorus magnetic resonance spectra of resting muscle were obtained from 4 patients with alternating hemiplegia of childhood. All patients had abnormally high resonance intensities from inorganic phosphate and an abnormally low calculated cytosolic phosphorylation potential. Two of the 4 patients had abnormally low resonance intensities from phosphocreatine and an abnormally high calculated cytosolic free adenosine diphosphate concentration. These abnormalities are indicative of mitochondrial dysfunction. The combination of a central nervous system disorder and evidence of mitochondrial dysfunction in muscle suggests that alternating hemiplegia of childhood may represent a previously unrecognized phenotype of mitochondrial disease.

Adenosine Diphosphate↗