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At least 451 records · Page 25Linked to original sources
PubMed2006

Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A.

OBJECTIVE: This randomised, double blind, placebo controlled, two parallel group study was conducted to assess the beneficial effect of injection of botulinum toxin A (Dysport) into the subscapularis muscle on shoulder pain in stroke patients with spastic hemiplegia. METHODS: A single dose of botulinum toxin A (500 Speywood units) or placebo was injected into the subcapularis muscle. Pain was assessed using a 10 point verbal scale. Subscapularis spasticity was assessed by the change in passive shoulder lateral rotation and abduction. Upper limb spasticity was assessed using the Modified Ashworth Scale for shoulder medial rotators, and elbow, wrist and finger flexors. Assessments were carried out at baseline and at weeks 1, 2 and 4. RESULTS: Twenty patients (10 patients per group), 11 with ischaemic stroke and 9 with haemorrhagic stroke, completed the study. Pain improvement with botulinum toxin A was observed from week 1; score difference from baseline at week 4 was 4 points versus 1 point with placebo (p = 0.025). Lateral rotation was also improved, with a statistically significant difference compared with placebo at week 2 (p = 0.05) and week 4 (p = 0.018). A general improvement in upper limb spasticity was observed; it was significant for finger flexors at week 4 (p = 0.025). CONCLUSIONS: Subscapularis injection of botulinum toxin A appears to be of value in the management of shoulder pain in spastic hemiplegic patients. The results confirm the role of spasticity in post-stroke shoulder pain.

Botulinum Toxins, Type A↗
PubMed1986

Weakness of head turning in hemiplegia: a quantitative study.

The strength of head turning was measured in normal subjects and in patients with hemiplegia of vascular origin. In normals the strength of head turning to the two sides was not significantly different. In most patients with a cortical, capsular or high brainstem lesion the strength of head turning away from the side of the lesion was reduced. In patients with a medullary lesion the strength of head turning towards the side of the lesion was reduced. The significance of these findings is discussed in relation to the cortical control of the sternocleidomastoid muscle and other muscles involved in the movement of head turning.

Adult↗
PubMed1990

Recovery of elbow function in voluntary positioning of the hand following hemiplegia due to stroke.

Elbow movement during voluntary positioning of the hand (with the arm supported against gravity) is described in a longitudinal study of five patients recovering from hemiplegia due to stroke. Over a twelve month period, four of the patients improved their speed of movement, three exhibiting slightly better recovery of elbow extension, one of flexion. In some instances co-contraction of the elbow agonist and antagonist (measured just before the onset of movement) decreased with time after stroke. The effects of contrasting movements at the shoulder on elbow movement were also studied. Estimates of recovery were generally similar whether patients kept the shoulder still or made movements that were synergic or counter-synergic to those of the elbow.

Adult↗
PubMed1993

Patients with spastic hemiplegia at different recovery stages: evidence of reciprocal modulation of early/late reflex responses.

Reflex electromyographic (EMG) muscle responses were recorded from abductor pollicis brevis (APB) and tibialis anterior (TA) muscles of fifty patients with spastic hemiplegia. Responses in the muscles were evoked during voluntary muscle contraction (about 20% of maximum voluntary effort) by submaximal but suprathreshold electrical stimulation of the median (at the wrist) and common peroneal (at the neck of the fibula) nerves respectively. Three EMG peaks (R1, R2 and R3) could be recorded after the direct muscle response (M). There was only a slight difference in R1-R2 latency interval of about 5 ms between upper and lower limbs on the unaffected side of the patients making it unlikely that this late response of the lower limb involves a long loop pathway, although this possibility cannot be discounted for the later, R3, response. Reflex behaviour was analysed for three clinical identifiable recovery stages of voluntary movements in the spastic limbs (synergistic, isolated and useful movements). The major finding was that an increase in the amplitude of the early response "R1" was associated with a decreased amplitude and delayed latency of the late response "R2" on the spastic side. The amplitude of R1 in the three different recovery stages decreased significantly, whereas the amplitude of R2 increased significantly with improvement of the functional stage of the limb. A significant negative linear correlation was found between R1 and R2 amplitude changes in upper as well as lower limbs. A refractoriness of the motor neuron pool as a possible explanation for the decreased R2 amplitude could be discounted. These findings together with recent work on reflex development in children support the hypothesis of reciprocal modulation of early and late reflex signals by supraspinal motor centers.

Adult↗
PubMed1998

Exercise induced steroid dependent dystonia, ataxia, and alternating hemiplegia associated with epilepsy.

This paper describes a 20 year old woman with a new combination of neurological impairments in which the motor phenomena were responsive to corticosteroid treatment. She had lifelong moderate learning impairment. A variable ataxia with cerebellar characteristics was present from early life, with early severe exacerbation when seizures were uncontrolled. Atypical absence and simple and complex partial seizures were present from the first year of life and EEG abnormalities were maximal in the right parietal region, concordant with a mild non-specific abnormality of the white matter in the region of the trigone. Episodes of alternating hemiplegia occurred from 11 years, unassociated with seizures. Exercise induced dystonia occurred from the age of 5. After 10-20 minutes walking, her right foot would turn in and the right leg would stiffen, followed by the left and by falling and inability to get up for several minutes. Prednisolone improved her ataxia and was associated with cessation of both seizures and exercise induced dystonia. This adds a new syndrome to the corticosteroid responsive motor disorders associated with epilepsy.

Adolescent↗
PubMed1979

Hip fracture after hemiplegia.

In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke. Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb.

Aged↗
PubMed1992

Idiopathic hypereosinophilic syndrome presenting as childhood hemiplegia.

A case of childhood hemiplegia due to idiopathic hypereosinophilic syndrome is reported. There was no cardiac lesion. The neurological complications associated with hypereosinophilic syndrome and the pathophysiological mechanism of neurotoxicity of human eosinophils are discussed. It is likely that the neurological deficit was due to eosinophilic neurotoxicity.

Child↗
PubMed1986

Right heart pressures and blood-gas tensions in ponies during exercise and laryngeal hemiplegia.

Right atrial, right ventricular, and pulmonary artery pressures, along with change in pleural pressure, were determined with catheter-tipped micromanometers in two groups of ponies at rest, as well as during moderate (trot; heart rate = 180 beats . min-1) and severe (gallop; heart rate = 220 beats . min-1) exercise performed on a treadmill. Group A (n = 8) ponies served as controls, and group B ponies (n = 6) had laryngeal hemiplegia (LH) induced by sectioning the left recurrent laryngeal nerve 20-29 days before the study. It was observed that LH ponies could not gallop for more than 45-90 s. With both levels of exertion, pressures in the right atrium, right ventricle, and pulmonary artery increased very significantly in normal ponies. The change in pleural pressure of galloping ponies was 30.4 +/- 2.9 cmH2O, and the respiratory (and stride) frequency was 138 +/- 4 breaths . min-1. During severe exercise in normal ponies, the systolic, mean, and diastolic pressures in the pulmonary artery were 107 +/- 7, 63.5 +/- 4.2, and 46 +/- 4 mmHg, despite the fact that no alveolar hypoxia could be detected. In LH ponies pulmonary artery pressures rose to levels observed in normal ponies, but during galloping, the change in pleural pressure (delta Ppl) (92 +/- 6 cmH2O) was three times that in normal ponies, and there was no synchronization of respiratory (86 +/- 6 breaths . min-1) frequency to stride frequency (142 +/- 3 strides . min-1). Despite these respiratory adjustments (decreased frequency and increased delta Ppl), arterial PO2 decreased and arterial PCO2 increased in galloping LH ponies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Blood flow in respiratory muscles during maximal exertion in ponies with laryngeal hemiplegia.

Laryngeal hemiplegia increases the respiratory effort required during exercise. By use of 15-micron-diam radionuclide-labeled microspheres, respiratory muscle blood flows were studied at rest, submaximal exercise (SE), maximal exercise (ME), and ME + adenosine (3 mumol X kg-1 X min-1) in nine healthy laryngeal hemiplegic (LH) ponies to ascertain whether vasodilator reserve in these tissues may be exhausted during SE, which caused maximal respiratory frequency (f) to be reached. Blood flows were also studied in the limb muscles, and data were compared with normal ponies (M. Manohar, J. Appl. Physiol. 60: 1571-1577, 1986). The heart rate, f, and change in pleural pressure in LH ponies during SE were 205 +/- 5 beats/min, 91 +/- 10 breaths/min, and 61.2 +/- 8.7 cmH2O. Corresponding values for ME were 223 +/- 2 beats/min, 90 +/- 7 breaths/min, and 75.1 +/- 5.2 cmH2O. The treadmill speed for SE was set at 75% of that for ME. Mean aortic pressure (161 +/- 9 mmHg), diaphragmatic (206 +/- 27 ml X min-1 X 100 g-1), and intercostal muscle (124 +/- 12 ml X min-1 X 100 g-1) blood flows in LH ponies increased markedly with SE and these values were not different from ME (170 +/- 5 mmHg, 293 +/- 40 ml X min-1 X 100 g-1, 167 +/- 15 ml X min-1 X 100 g-1, respectively). This suggested that maximal vasodilation in the respiratory muscles was achieved during SE. Vascular resistance in the diaphragm and intercostal muscles of LH ponies also remained similar for SE, ME, and ME + adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1979

Semiological value of the palmo-mental reflex in vascular hemiplegia.

The palmo-mental reflex has been described, together with other neurological signs, in senile dementia. It is, however, found in normal adults, where its frequency increases with age. In vascular hemiplegia it has a considerably higher incidence, nevertheless it is not a sign of mental deterioration.

Adolescent↗
PubMed1980

Motor evaluation in vascular hemiplegia.

In vascular hemiplegia, motricity of the upper and lower limbs can be assessed from the examination of a limited number of movements which have been selected by a statistical procedure. For these movements the scores may be weighted on the basis of progress achieved over 2, 4 and 6 months. From the weighted, summed and averaged scores, a motricity index may be derived. This index gives a rapid overall indication of a patient's progress in motor recovery, permits comparisons between different patients and the establishment of correlations with other clinical data and the values obtained by paraclinical techniques.

Aged↗
PubMed1985

Delayed contralateral hemiplegia following herpes zoster ophthalmicus: should antiviral therapy be used?

We review clinical virological studies in the syndrome of delayed contralateral hemiplegia following herpes zoster ophthalmicus. Virus could not be isolated from the cerebrospinal fluid (CSF) of the present case, nor was antiviral antibody found in the CSF. There appear to have been no reports of successful virus isolation from the CSF although there are reports of antibody in the spinal fluid. Thus the evidence for ongoing viral replication in the central nervous system is marginal. It is suggested that the sensitive antibody assay against membrane antigens (FAMA) be used in the future as a guide to antiviral therapy.

Adult↗
PubMed1989

Giant-cell arteritis presenting with ipsilateral hemiplegia and lateral medullary syndrome.

We describe the clinical and anatomopathological findings in an 85-year-old male presenting with a lateral medullary syndrome and ipsilateral hemiplegia (Opalski's syndrome) due to giant-cell arteritis of the vertebral artery. Other common associated symptoms of the disease were absent, and the erythrocyte sedimentation rate was only of 30 mm/h. This case emphasizes that limited intracranial giant-cell arteritis may present rarely as a stroke.

Aged↗
PubMed2005

Functional recovery after hemiplegia in patients with neglect: the rehabilitative role of anosognosia.

BACKGROUND AND PURPOSE: The aim of this study was to verify whether the presence of anosognosia (A) affects the rehabilitative prognosis of hemiplegic subjects with neglect (N). METHODS: This study was carried out on 30 patients with left hemiplegia: 15 patients had neglect (group N) and 15 had neglect and anosognosia (group N+A). Mean age was 68.2+/-6.3 in group N (9 men and 6 women) and 72.1+/-6.4 in group N+A (7 men and 8 women). The average interval from onset of stroke to admission for rehabilitation was 23 and 23.6 days, respectively, in group N and in group N+A. Patients were assessed through the Mesulam test, Bisiach test, Wechsler Adult Intelligence Scale, Fugl-Meyer scale, Functional Independence Measure (FIM), and Rankin scale. RESULTS: Before rehabilitation, cognitive FIM scores of patients of group N were significantly higher than those of group N+A (P=0.001), whereas motor FIM scores and total FIM scores did not differ between the 2 groups. After rehabilitation, cognitive FIM scores (P=0.000) and even motor (P=0.009) and total FIM scores (P=0.000) were statistically higher in group N than in group N+A. Effectiveness (P=0.005) and efficiency (P=0.012) in the motor FIM scores of group N were significantly greater than those of group N+A. Disability was lower in group N (P=0.040). CONCLUSIONS: Our study shows that the presence of anosognosia worsens the rehabilitation prognosis in hemiplegic subjects who also have neglect.

Aged↗
PubMedDate not supplied

Pure motor hemiplegia: CT study of 30 cases.

Pure motor hemiplegia (PMH) is a well defined syndrome usually caused by ischemic lesions of lacunar type located either in the internal capsule or in the pons. Angiography and isotope scanning are usually normal. CT scan reveals small deep infarcts and appears to be the most reliable investigative method. The CT scan findings are described of thirty patients with PMH of rapid onset (less than 36 hours). In 29 of the 30 cases a lesion was found which could explain the PMH. Small hemorrhages (2 cm in diameter) in the posterior limb of the internal capsule were noted in two cases. Ischemic lesions were found in 27 patients, 22 patients had a single lesion (20 capsular and 2 pontine), while 5 patients had 2 lesions (2 bi-capsular, 3 capsular and pontine). Three varieties of ischemic capsular lesions were observed. We found in 15 cases a capsulo-putamine-caudate infarct (type I); in 8 cases a capsulo-pallidal infarct (type II); and in 2 cases an anterior capsulo-caudate infarct (type III). Type I corresponded to the area of the lateral lenticulostriate branches of the middle cerebral artery. Type II involved the territory of the perforating branches of the anterior choroidal artery. We suggest that type III involves the territory of the internal lenticulostriate branches of the anterior cerebral artery. Lacunes are generally linked to arterial systemic hypertension. However, only 16 of 30 patients in this series were chronically hypertensive.

Adolescent↗
PubMed1988

Prognosis of acute hemiplegia estimated by transcranial Doppler ultrasonography.

Blood velocity in the middle cerebral artery was measured by transcranial Doppler ultrasonography in 15 patients suffering complete hemiplegia of less than 12 hours' duration, presumed due to cerebral ischemia. Among seven patients in whom blood velocity was greater than 30 cm/sec, five made complete or partial useful recovery of the involved hand and arm. Among eight patients in whom blood velocity was less than 30 cm/sec, one recovered completely while the other seven retained permanent total paralysis of the hand and arm.

Acute Disease↗
PubMed1995

Hemiplegia vegetativa alterna (ipsilateral Horner's syndrome and contralateral hemihyperhidrosis) following proximal posterior cerebral artery occlusion.

BACKGROUND: Posterior cerebral artery (PCA) occlusive disease usually produces homonymous visual field defects, hemisensory loss, and neuropsychological deficits. Conversely, the combination of hemiparesis, Horner's syndrome, and contralateral hemihyperhidrosis has never been reported before. CASE DESCRIPTION: A patient with infarction in the superficial and deep territories of the right PCA presented with a unique clinical picture, which included contralateral hemiparesis, hemihyperhidrosis, and ipsilateral Horner's syndrome. Magnetic resonance imaging disclosed infarcts in the right anterolateral midbrain, ventroposterolateral thalamic-subthalamic area, and temporo-occipital lobes. CONCLUSIONS: The alternating vegetative syndrome (hemiplegia vegetativa alterna) observed in this patient supports the hypothesis of the existence of an uncrossed excitatory and a crossed inhibitory hypothalamospinal sympathetic pathway.

Adult↗
PubMed1997

Amelioration of hemiplegia-associated osteopenia more than 4 years after stroke by 1 alpha-hydroxyvitamin D3 and calcium supplementation.

BACKGROUND AND PURPOSE: It has been demonstrated that bone mass was significantly reduced on the hemiplegic side of stroke patients, which might increase their risk of hip fracture. We evaluated the efficacy of 1 alpha-hydroxyvitamin D3 [1 alpha (OH)D3] and supplemental elemental calcium in maintaining bone mass and decreasing the incidence of hip fractures after hemiplegic stroke. METHODS: In a randomized study, 64 patients with hemiplegia after stroke with a mean duration of illness of 4.8 years received either 1 microgram 1 alpha (OH)D3 daily (treatment group, n = 30) or an inactive placebo (placebo group, n = 34) for 6 months and were observed for this duration. Both groups received 300 mg of elemental calcium daily. The bone mineral density (BMD) and metacarpal index (MCI) in the second metacarpals were determined by computed x-ray densitometry. The incidence of hip fractures in these patients was recorded. RESULTS: BMD on the hemiplegic side decreased by 2.4% in the treatment group and 8.9% in the placebo group (P = .0021), while BMD on the intact side increased by 3.5% and decreased by 6.3% in the treated and placebo groups, respectively (P = .0177). In the treatment group, the difference in BMD between hemiplegic and nonhemiplegic sides decreased significantly compared with that before randomization. This difference increased in the placebo group. We observed a similar improvement in MCI in the treatment group but not in the placebo group. Four patients in the placebo group suffered a hip fracture compared with none in the treatment group (P = .0362). CONCLUSIONS: Treatment with 1 alpha (OH)D3 and supplemental elemental calcium can reduce the risk of hip fractures and can prevent further decreases in BMD and MCI on the hemiplegic side of patients with a long-standing stroke. Treatment also may improve these indices on the intact side.

Absorptiometry, Photon↗