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PubMed1992

Alternating hemiplegia of childhood: case report.

We report the case of a 3 1/2 year old girl who had had attacks of alternating hemiplegia from the age of 6 months. Peculiar features from the etiopathogenetic angle seem to be the presence of a ring of mild stenosis of the vertebral artery on the right side, the influence of the upright posture on the onset of the attacks and perhaps also of variations in atmospheric pressure. The only drug that had some effect was flunarizine. Phenobartbital, haloperidol and nadolol had no appreciable effect.

Child, Preschool↗
PubMedDate not supplied

Mumps hemiplegia.

Neurological involvement of mumps is commonly restricted to aseptic meningitis. However, rarely mumps is associated with more severe encephalitic illness; other known associations described with mumps are cases of transverse myelitis and Gullain Barre like illness. We report a case of hemiplegia due to mumps parotitis probably caused by involvement of carotid artery.

Carotid Artery, Internal↗
PubMed1981

Hemiplegia and retrobulbar neuritis after subarachnoid block.

A 25 year old man was given a subarachnoid anaesthetic for repair of hydrocele. He developed left-sided hemiplegia and retrobulbar neuritis three hours after the procedure. He recovered 45 days later after steroid therapy. There was some residual neurological deficit. The differential diagnosis is discussed.

Adult↗
PubMed2000

[Somatoparaphrenia. A positive variant of anosognosia for hemiplegia].

Anosognosia for hemiplegia (AHP), i.e., unawareness of motor deficits and associated disorders, has been frequently reported, pre-dominantly following right hemispheric lesions. To a smaller extent, there are case reports of patients who give accounts of a feeling of strangeness concerning the contralesional limbs and sometimes attribute them to other persons. This "positive-variant" of AHP has been labeled "somatoparaphrenia" (SP). We report a case of SP in a 85-year-old woman with infarction of the right posterior cerebral artery and posterior parts of the right thalamus. She showed AHP and described her left side alternatively as her handicapped nephew and a clumsy cat. Misidentification of her daughter also occurred. With respect to the literature the predominant neuroanatomical features involved are lesions including right parietal cortex and/or posterior parts of the thalamus. Theories concerning the pathogenesis of this phenomenon comprise a denial of the illness, a lack of awareness caused by reduced sensory feedback and neglect, a misidentification or disturbance of the active discovery process considered necessary for realizing one's disorder.

Aged↗
PubMed2006

Children with congenital spastic hemiplegia obey Fitts' Law in a visually guided tapping task.

Fitts' Law is commonly found to apply to motor tasks involving precise aiming movements. Children with cerebral palsy (CP) have severe difficulties in such tasks and it is unknown whether they obey Fitts' Law despite their motor difficulties. If Fitts' Law still does apply to these children, this would indicate that this law is extremely robust and that even performance of children with damaged central nervous systems can adhere to it. The integrity of motor control processes in spastic CP is usually tested in complex motor tasks, making it difficult to determine whether poor performance is due to a motor output deficit or to problems related to cognitive processes since both affect movement precision. In the present study a simple task was designed to evaluate Fitts' Law. Tapping movements were evaluated in 22 children with congenital spastic hemiplegia (CSH) and 22 typically developing children. Targets (2.5 and 5 cm in width) were placed at distances of 10 and 20 cm from each other in order to provide Indices of Difficulty (ID) of 2-4 bits. Using this Fitts' aiming task, prolonged reaction and movement time (MT) were found in the affected hand under all conditions in children with CSH as compared to controls. Like in the control group, MT in children with CSH was related to ID. The intercept 'a', corresponding to the time required to realize a tapping movement, was higher in the affected hand of the children in the CSH group. Although, the slope b (which reflects the sensitivity of the motor system to a change in difficulty of the task) and the reciprocal of slope (that represents the cognitive information processing capacity, expressed in bits/s) were similar in both groups. In conclusion, children with CSH obey Fitts' Law despite very obvious limitations in fine motor control.

Adolescent↗
PubMed1999

Dissection of the middle cerebral artery caused by invasion of malignant glioma presenting as acute onset of hemiplegia.

A 57-year-old, previously healthy man who developed acute onset of hemiplegia is presented. Neuro-imaging studies on admission suggested dissection of the middle cerebral artery producing infarction in the frontotemporal region. In contrast to his stable clinical course, serial neuro-imaging studies disclosed rapid growth of malignant glioma, which was confirmed at surgery. Microscopic examination of the surgical specimen demonstrated invasion of glioma cells into the arterial wall associated with intramural haematoma formation of the middle cerebral artery. This case is the first to document dissection of an intracranial artery caused by invasion of tumour cells.

Acute Disease↗
PubMed1994

Impaired afferent control in patients with spastic hemiplegia at different recovery stages: contribution to gait disorder.

The cerebral somatosensory potentials (SEP) evoked by electrical stimulation of the tibial nerve on the affected and unaffected limbs during stance and gait were recorded in 50 patients with spastic hemiplegia. On the unaffected side, the onset of the cortical activation during gait was 15 to 20ms later, and the amplitude was about 50% smaller than that recorded during stance condition. This was attributed to blocking of Ia afferent fibers during gait. SEPs recorded on the affected side during gait were, in general, of smaller amplitude and appeared with a shorter latency than in the unaffected side. During gait, 22 affected limbs showed a "Ia" blocking pattern of SEPs whereas another 28 showed a nonblocking pattern. The behavior of SEPs was analyzed with respect to three clinical identifiable recovery stages of voluntary movements in the spastic limbs (namely synergistic, isolated, and useful movements). The blocking pattern during gait was usually present in good functioning limbs, whereas the nonblocking pattern was usually present in poorly functioning limbs. It is concluded that the change in the gait pattern of hemiparetic patients represents a shift from good relevant functioning group II-afferent system to a predominance of functionally ineffective group I-afferent system.

Adult↗
PubMed1991

Disuse of anterior tibial muscle during locomotion and increased proportion of type II fibres in hemiplegia.

The tibialis anterior (TA) is a muscle activated mainly during walking. Its use during the step cycle was studied in 10 patients (55.8 +/- 8.8 years) with chronic hemiplegia (duration 3-18 years) and related to the muscle fibre composition, size and expression of isoforms of myosin heavy chains (MHCs). In the average step cycle the integrated surface EMG of the paralysed TA did in the majority of the hemiplegic patients not exceed 10% of that recorded during maximal contraction of the normal leg. The type I fibre percentage in the paralysed TA subject was 57.4% as compared with 79.4% in normal muscles (P less than 0.05). The range of axonal conduction velocities in the peroneal nerve did not differ in paralysed and non-paralysed leg, suggesting that there was no selective loss of one class of motoneurons. The type II fibres consisted of IIA (66%) and IIB (31%), in contrast to the normal TA muscle where less than 1% of the muscle fibres are of type IIB. The incidence of fibres in the biopsies with both slow and fast MHCs had a mean value of 3.5% (range 0.7-9%). The type I and type II muscle fibres had normal sizes with cross-sectional area 4511 +/- 962 microns 2 and 6181 +/- 1062 microns 2. No selective type II atrophy was seen. Occasional hypertrophic type I and II fibres were seen in 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Aimed movements to visual targets in hemiplegic and normal children: is the "good" hand of children with infantile hemiplegia also normal?

The accuracy, reaction and movement time of pointing movements to visual targets were examined in children aged 3-13 yr with infantile hemiplegia and compared to those of comparably aged normal children. Hemiplegic children pointed with the "good" hand (i.e. ipsilateral to the lesion). Half the normal children used the preferred hand, half the non-preferred hand. Movements were made with unrestricted/restricted visual feedback, when movement distance was short/medium/long, and when number of target alternatives were 2/4/8. Normal children using the preferred hand were more accurate but reacted more slowly than children using the non-preferred hand. The performance of most of the hemiplegic children with bilateral and/or unilateral lesions was impaired; degree of accuracy was related to the extent of the brain lesion; and reaction time was related to the level of intelligence. It was concluded that unilateral lesions in children can result in bilateral visuomotor impairment.

Adolescent↗
PubMed1992

Pathological left-handedness revisited: dichotic listening in children with left vs right congenital hemiplegia.

Thirty-one children with right (n = 18) and left (n = 13) congenital hemiplegia were compared for incidence of hand- and foot-preference, eye-dominance, and familial sinistrality. In addition, they were tested with dichotic listening for correct reports of consonant-vowel syllables. The two groups of children were closely matched on IQ and sensory functioning. Children with mental retardation, or epileptic seizures were not included. The results showed that 89% of the left hemisphere impaired (LHI) children were left-handed, all of them preferred the left foot, and 72% were left eye-dominant. In the right hemisphere impaired (RHI) group, everyone (100%) preferred the right hand and foot, and 62% were right eye dominant. The dichotic listening results showed a significant right ear advantage (REA) in the RHI-group, and a significant left ear advantage (LEA) in the LHI-group. The results are discussed in the framework of pathological handedness and shifts in hemisphere control of language in children with early brain injury. It is argued that the homogeneous samples, except for the site of lesion, provides an interesting possibility to compare cognitive effects of left and right hemisphere impairment in children.

Adolescent↗
PubMed1996

Inverse relationship between sensation of effort and muscular force during recovery from pure motor hemiplegia: a single-case study.

A 39-year-old patient with a right pure motor hemiplegia, who complained of a striking sensation of effort when he performed a movement, was regularly examined during 4 months. The effort sensation and the force recovery have been measured during the execution of upper limb movements: shoulder antepulsion up to horizontal, supined elbow flexion up to horizontal and full hand digital grip. The subject was asked to realize a movement with the paretic arm and to concentrate on the felt effort; then he had to perform the same movement against a resistance with the healthy arm, until the perceived heaviness matched the effort sensation felt on the other side. Recovery of force and evolution of effort sensation did not follow linear trends over time. The curves displayed significant steps and plateaus, which were mainly observed for the proximal movements. The steps tended to be clustered within a few days, consistent with crucial periods in the restoration process. Within these, significant reduction of the effort sensation and increase of the force were together observed. These critical moments of the motor recovery could be analyzed as the result of an improvement of the neural traffic in the internal capsule and an activation of specific structures involved in the representation of the force and effort.

Adult↗
PubMed1994

Methylphenidate treatment following ablation-induced hemiplegia in rat: experience during drug action alters effects on recovery of function.

Two experiments examined the effects of single or multiple administrations of methylphenidate (MPH; Ritalin) and differing amounts of beam-walking trials (symptom relevant experience) during the period of drug action on recovery from hemiplegia following unilateral sensorimotor cortex ablation in rat. The first study tested multiple doses of MPH (10 mg/kg) or sterile saline given once daily, followed by four beam-walk (BW) trials at 1, 2, 3, and 6 h on 3 consecutive days. A significant and enduring enhancement of recovery was only observed 24 h after the third administration of MPH, compared to saline controls. In the second study, a single dose of MPH (10 mg/kg) or saline was administered 24 h after ablation, followed by 12 BW trials beginning 1 h and continuing at 15-min intervals until 3 h after MPH or saline administration. A significant and enduring facilitation of BW ability was produced by this single MPH treatment regimen. These data further support the importance of an interaction between symptom-relevant experience and drugs that increase norepinephrine transmission to enhance functional recovery after brain damage.

Animals↗
PubMedDate not supplied

Recovery from GABA-mediated hemiplegia in young and aged rats: effects of catecholaminergic manipulations.

We investigated the participation of catecholaminergic mechanisms in the functional recovery from motor cortex lesions in young (9 months) and aged (26 months) rats. The animals were studied during the recovery period from an hemiplegic syndrome secondary to small motor cortex lesions potentiated by the localized, chronic (7 days) infusion of GABA into the lesion site. Acute administration of haloperidol (0.1 mg/kg IP) to these recovered animals induced a re-emergence of the contralateral motor syndrome in both groups. In the young group, the haloperidol-induced hemiplegia lasted one day whereas in the aged animals the deficit was significantly prolonged lasting three days. Apomorphine administration (0.5 mg/kg IP) prior to or immediately after haloperidol injection failed to prevent or reverse the reappearance of the motor deficit. Adult animals recovered from motor cortex aspirations performed 7 to 12 months prior were refractory to haloperidol effects. Amphetamine administration to young rats treated chronically with saline or GABA infusion into the somatomotor region also failed to alter the clinical evolution of the motor deficit. The evidence suggests that dopaminergic mechanisms are involved in the functional recovery from brain lesions and that these mechanisms are most susceptible to neuroleptic blockade during the early post-lesional period. The deleterious effects of dopaminergic blockade are heightened in aged populations. The use of dopaminergic antagonists in brain-lesioned subjects, and particularly in geriatric populations, is considered potentially harmful, particularly in the early stages of the recovery process.

Aging↗
PubMedDate not supplied

Motor function of infants with spastic hemiplegia.

The motor function of 25 children with spastic hemiplegia was examined retrospectively using videotapes recorded at 2-8 months of age. Many infants showed deficient forward movement of the arm and deficient opening of the hand on the affected side. At 7 and 8 months of age, whether the hand was semiflexed or clenched was correlated with the later upper extremity function. In the prone position, most could support their weight on the flexed arm on the affected side. In the supine position, half of the infants could not extend the knee on the affected side. At 2 months of age, asymmetry of the upper and lower extremity movements was not identified. Persistent primitive reflexes and abnormal truncal muscular tone were not recognized in the hemiplegic infants, and did not seem to be signs predicting hemiplegic cerebral palsy.

Cerebral Palsy↗
PubMedDate not supplied

Alternating hemiplegia in childhood: a cross-sectional study.

Six patients with alternating hemiplegia in childhood (AHC) were followed, some of them up to childhood. Progressive intellectual deterioration and disturbance of pyramidal, extrapyramidal and cerebellar functions were found in all of them. Multimodal evoked potential abnormalities, changes of sleep structure and HMPAO-SPECT results were correlated with increasing clinical handicap. In older patients increases in the plasma level of lactate, as well as in the lactate: pyruvate ratio, were revealed, accompanied by elevated inorganic phosphate (Pi) values on 31P MR spectroscopy. These findings support the hypothesis of a possible secondary mitochondrial deficit in AHC. However, no specific bioptic changes (muscle, skin, or buccal mucous membrane) were found, and thus the etiology of AHC remains unclear.

Adolescent↗