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PubMed2004

Acute hemiplegia associated with cat-scratch disease.

Cat scratch disease (CSD) is an infectious illness caused by a Gram-negative rod named Bartonella henselae. Typical CSD is characterized by a small skin lesion at the site of a scratch or a bite, followed by regional lymphadenopathy, one to two weeks later. Atypical forms may present as ocular manifestations, neurological manifestations, hepatosplenic involvement and vertebral osteomyelitis. Among neurological complications, encephalopathy is by far the most common. Other neurological manifestations are very rare. We report a case of an 11-year-old boy, with a posterior cervical lymphadenopathy and fever. Cat scratch disease was diagnosed and treated after a positive "Whartin-Starry" stain on lymph node biopsy. Two weeks after treatment, the patient was readmitted presenting an acute episode of left hemiplegia. A brain MRI demonstrated a right subcortical fronto-parietal lesion with no contrast enhancement. Complete recovery was observed after corticosteroid treatment.

Acute Disease↗
PubMedDate not supplied

Glenohumeral subluxation in hemiplegia: An overview.

This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies.

Causality↗
PubMed1989

[Hemiplegia cruciata caused by a stab wound of the spinal cord. Case report].

A 56-year-old female sustained a neck laceration by a piece of glass, which broke when she fell backward. She immediately became quadriplegic and was transported to a local hospital, then deteriorated and was referred to the authors' hospital. Neurological examination revealed quadriplegia that was particularly pronounced in the right arm and left leg. Pain sensation was decreased in the right upper and lower extremities below the C3 level. Cervical spine films showed glass fragments in the gap between the occipital bone and the C1 arch. Computed tomography dramatically demonstrated glass fragments that had become fixed in the spinal cord at the spinomedullary transition. A suboccipital craniectomy and C1 laminectomy allowed visualization of the dural laceration. Opening of the dura exposed a glass fragment penetrating the upper cervical spine just caudal to the left tonsil. It was successfully removed with a hemostat clamp. Postoperatively, the patient was soon able to walk without assistance. To the authors' knowledge, upper cervical spinal cord injury caused by glass has previously been reported only twice, although broken glass is a common cause of wounds. Also, this patient exhibited signs of "hemiplegia cruciata," which is thought to be due to damage to the pyramidal decussation.

Female↗
PubMed2001

Spectrum analysis of respiratory sounds in exercising horses with experimentally induced laryngeal hemiplegia or dorsal displacement of the soft palate.

OBJECTIVE: To record respiratory sounds in exercising horses and determine whether spectrum analysis could be use to identify sounds specific for laryngeal hemiplegia (LH) and dorsal displacement of the soft palate (DDSP). ANIMALS: 5 Standardbred horses. PROCEDURE: Respiratory sounds were recorded and pharyngeal pressure and stride frequency were measured while horses exercised at speeds corresponding to maximum heart rate, before and after induction of LH and DDSP. RESULTS: When airway function was normal, expiratory sounds predominated and lasted throughout exhalation. After induction of LH, expiratory sounds were unaffected; however, all horses produced inspiratory sounds characterized by 3 frequency bands centered at approximately 0.3, 1.6, and 3.8 kHz. After induction of DDSP, inspiratory sounds were unaffected, but a broad-frequency expiratory sound, characterized by rapid periodicity (rattling) was heard throughout expiration. This sound was not consistently detected in all horses. CONCLUSIONS AND CLINICAL RELEVANCE: The technique used to record respiratory sounds was well tolerated by the horses, easy, and inexpensive. Spectrum analysis of respiratory sounds from exercising horses after experimental induction of LH or DDSP revealed unique sound patterns. If other conditions causing airway obstruction are also associated with unique sound patterns, spectrum analysis of respiratory sounds may prove to be useful in the diagnosis of airway abnormalities in horses.

Animals↗
PubMed2006

Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Recent studies have evaluated surgical techniques aimed at reducing noise and improving airway function in horses with recurrent laryngeal neuropathy (RLN). These techniques require general anaesthesia and are invasive. A minimally invasive transnasal surgical technique for treatment of RLN that may be employed in the standing, sedated horse would be advantageous. OBJECTIVE: To determine whether unilateral laser-assisted ventriculocordectomy (LVC) improves upper airway function and reduces noise during inhalation in exercising horses with laryngeal hemiplegia (LH). METHODS: Six Standardbred horses were used; respiratory sound and inspiratory transupper airway pressure (Pui) measured before and after induction of LH, and 60, 90 and 120 days after LVC. Inspiratory sound level (SL) and the sound intensities of formants 1, 2 and 3 (Fl, F2 and F3, respectively), were measured using computer-based sound analysis programmes. In addition, upper airway endoscopy was performed at each time interval, at rest and during treadmill exercise. RESULTS: In LH-affected horses, Pui, SL and the sound intensity of F2 and F3 were increased significantly from baseline values. At 60 days after LVC, Pui and SL had returned to baseline, and F2 and F3 values had improved partially compared to LH values. At 90 and 120 days, however, SL increased again to LH levels. CONCLUSIONS: LVC decreases LH-associated airway obstruction by 60 days after surgery, and reduces inspiratory noise but not as effectively as bilateral ventriculocordectomy. POTENTIAL RELEVANCE: LVC may be recommended as a treatment of LH, where reduction of upper airway obstruction and respiratory noise is desired and the owner wishes to avoid risks associated with a laryngotomy incision or general anaesthesia.

Animals↗
PubMed1984

Respiration in tetraplegia and in hemiplegia: a review.

Impairment of respiratory function is one of the most serious complications of both complete cervical cord injury and stroke with hemiplegia. This review updates the information first gathered 15 years ago. The overall improvement in prognosis is documented and the methods of treatment, including diaphragmatic pacing and physiotherapy are discussed.

Cerebrovascular Disorders↗
PubMed2003

Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report.

The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

Aneurysm↗
PubMed1990

108 cases of hemiplegia caused by stroke: the relationship between CT scan results, clinical findings and the effect of acupuncture treatment.

The location of the pathological focus on the film of CT scan was related to the degree of paralysis, and to the result of acupuncture in hemiplegia patients. In retrospective analysis of the clinical data, we found some inter-linking relationships. In general, early treatment (first 3 weeks) with acupuncture produces better result (improvement in 90.9% of the patients treated) than the treatment initiated three weeks after stroke (improvement in 71.4% of the patients treated).

Acupuncture Therapy↗
PubMed1989

Cerebral hemispherectomy for seizures with hemiplegia.

The risk-benefit ratio of this functionally complete but anatomically subtotal hemispherectomy is strongly in favor of its more widespread and early use for the small group of unfortunate seizure patients who have maximal or near maximal hemiplegia and a complete or high-grade hemianopsia, and whose seizures constitute a significant handicap in regard to schooling and psychosocial development despite an adequate trial of appropriate antiepileptic medication. The earlier the "good" hemisphere and the upper brain are spared the nociferous effect of continual bombardment by wide-spread high-amplitude epileptiform discharges, the more effectively motor, sensory, intellectual, and psychosocial development can take place in the remainder of the nervous system.

Brain↗
PubMed2006

[Adjustment of middle-aged people with hemiplegia after a stroke].

PURPOSE: The purpose of this study was to understand the adjustment process of middle-aged people in Korea with hemiplegia after a stroke. METHOD: For this study, the grounded theory method was utilized. RESULTS: After constant comparative analysis, the core category emerged as 'rebuilding the body which was ruined'. In addition, the causal conditions were 'restriction of physical function', and 'loss of roles'. The adjustment process consisted of the 'facing reality phase', 'overcoming depression phase', 'overcoming physical limits phase' and 'reestablishing roles phase'. The main strategies in the facing reality phase were 'holding on to a glimmer of hope', 'getting away from the harsh reality' and 'facing up to the reality'. The main strategies in the overcoming depression phase were 'soothing oneself', 'Self-introspection' and 'restoring self-esteem'. In addition, the main strategies in the self-initiative overcoming physical limits phase was 'discovering personal strategies and striving to recover'. The main strategies in the reestablishing roles phase were 'reestablishing a parents' role', 'reestablishing a spouse's role' and 'reestablishing social roles'. CONCLUSION: In conclusion, even though many middle aged stroke patients remained in the depression phase, most of them who overcame depression strived to conquer physical limits on their own initiative.

Adaptation, Psychological↗
PubMed1981

A survey of rationales for and against hand splinting in hemiplegia.

This study investigated rationales underlying splinting decisions involving patients with hemiplegia. The survey incorporated a limited-choice, multiple-option questionnaire based on the case study of a man with a left hemiparesis at three hypothetical stages of recovery. Ninety-three occupational therapists who answered indicated whether they would or would not recommend a splint at each stage, and selected one or more reasons for their decisions. The respondents fell into three major categories: those who would 1. never splint, 2. always splint, and 3. splint only in the presence of moderate to severe spasticity. Those with longer clinical experience reflected more tendency to splint. The results indicated conflicting practices in splinting and showed the need for further clinical research in this area.

Aged↗
PubMed1990

Upper extremity casting: adjunct treatment for a child with cerebral palsy hemiplegia.

A common upper extremity deformity with hemiplegia is pronation contracture of the forearm in association with flexion contracture of the elbow. Early management of the child with hemiplegic cerebral palsy is critical in optimizing overall function. The use of inhibitory upper extremity casting can enhance function and improve arm-hand position. The present paper describes the evaluation process before casting, the goals of each phase of the casting program, and the follow-up.

Arm↗
PubMed1991

Motor learning concepts applied to activity-based intervention with adults with hemiplegia.

This paper presents a framework for the integration of motor learning research findings with a neurodevelopmental treatment perspective. The importance of activity-based intervention is emphasized, and a strategy for activity synthesis is presented. Clinical problems seen in persons with hemiplegia are used to clarify concepts and illustrate therapeutic interventions.

Hemiplegia↗
PubMed1995

Validity of clinical measures of shoulder subluxation in adults with poststroke hemiplegia.

OBJECTIVES: Shoulder subluxation after cerebrovascular accident has been associated with chronic pain, orthopedic complications, peripheral nerve damage, and autonomic dysfunction. Clinical diagnosis and gradation of subluxation is problematic due to the lack of precision in frequently used measures. The objective of this study was to assess the validity of clinical techniques used to assess inferior subluxation of the hemiplegic shoulder by comparing these techniques with radiographic measurement. METHOD: In 20 male subjects with hemiplegia, the presence, type, and degree of subluxation was assessed with three clinical measures: palpation, arm length discrepancy, and thermoplastic jig measurement. Anterior-posterior X rays of the hemiplegic shoulder were taken after clinical examination. RESULTS: Spearman rank correlation coefficients between the X rays and the three clinical measures were relatively low. Palpation had the highest correlation (rs = .76), followed by arm length discrepancy (rs = .46), and thermoplastic jig measurement (rs = .42). CONCLUSION: These findings provide cautious optimism about using these clinical measures to identify subluxation. Although detection was best with palpation, the likely inability to determine clinical overcorrecting of subluxation makes use of palpation alone suspect. Improved techniques of arm length measurement may provide a solution to this problem. These findings further necessitate that improved procedures for clinical assessment of subluxation be developed.

Adult↗
PubMed1994

Concurrent development of hemiplegia and angina pectoris in a 46-year-old man with familial hypercholesterolemia and elevated serum Lp(a) concentrations.

We report a 46-year-old man with familial hypercholesterolemia who simultaneously developed angina pectoris and left hemiplegia. Angiography revealed complete tapering occlusion of the right internal carotid artery and a 75% stenosis of the right coronary artery. In addition to hypercholesterolemia, his serum Lp(a) levels were very high, with a mean (+/- SE) of 62 +/- 2 mg/dl.

Angina Pectoris↗
PubMed1976

Oerative treatment of the plantar-flexed inverted foot in adult hemiplegia.

From a population of 902 adult patients with acquired hemiplegia, thirty-two patients with extensor synergy were chosen for a reconstructive procedure designed to eliminate the need for an orthosis. Three additional patients underwent the procedure to eliminate severe spasticity which precluded orthotic fitting. The operative technique, first described by Mooney and associates, involved lengthening of the tendo achillis and tibialis posterior tendon, multiple toe-flexor tenotomies, and a split transfer of the tibialis anterior tendon. Satisfactory results were recorded for thirty-two patients. The three failures were ascribed to inappropriate selection of patients for surgery.

Achilles Tendon↗
PubMed1999

Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia.

OBJECTIVES: To study the correlation between spasticity and motor dysfunction in the wrist-hand unit of adult hemiplegic patients, and to investigate the correlation between clinical spasticity and hyperactive stretch reflexes. STUDY DESIGN: A survey study with a sequential case series of subjects. SETTING: Neuromuscular Research Laboratory, School of Physical Therapy, Texas Woman's University, Houston, TX. SUBJECTS: Sequential sample recruited from local stroke support groups: 10 patients with chronic hemiplegia caused by cerebral vascular accident who had various degrees of spasticity in the wrist joint. OUTCOME MEASURES: Modified Ashworth Scale, amplitudes of stretch reflexes for wrist flexors, grip strength, active range of motion of the wrist joint, and Fugl-Meyer test. RESULTS: Strong reverse correlation was found between spasticity and grip strength, the Fugl-Meyer test scores, and the Box and Blocks test scores (p = .001 to .005). Results also indicated a strong and consistent correlation between spasticity and reflexive electromyographic activities of the stretch reflex recorded from active muscles (p = .005 and .007), but not between spasticity and torque response of the stretch reflex. CONCLUSIONS: The degree of wrist spasticity is associated with impaired hand function in hemiplegic patients, and hyperactive electromyographic response of the stretch reflex, recorded from active muscles, is a valid indicator of spasticity.

Aged↗
PubMed1999

[Neuroimaging findings of hemiconvulsions, hemiplegia, epilepsy (HHE) syndrome].

A 32-year-old man with hemiconvulsions, hemiplegia, epilepsy (HHE) syndrome is described. He was well developed with a normal pregnancy and delivery, but at age 10 months, he had status epilepticus during a febrile illness. Thereafter, he was noted to have left hemiparesis and mental retardation with recurrent hemiconvulsions. Magnetic resonance (MR) images showed atrophy and degeneration of the right cerebral cortex and white matter, homolateral thalamus, caudate nucleus, and hippocampus, with hyperintensities in both T2-weighted (TR/2200, TE/90) and proton (TR/2200, TE/30) images. There were also slight bilateral cerebellar atrophies. Quantitative single photon emission computed tomographic (SPECT) images using technetium-99m-ethyl cysteinate dimer (99mTc-ECD) revealed markedly reduced cerebral blood flow (CBF) in the right cerebral hemisphere, homolateral thalamus, caudate nucleus and bilateral cerebellum. Bilateral putamen and the medial occipital lobe showed normal findings on MR images and normal regional CBF in SPECT images. We suppose these selective neuronal injures in this case of HHE syndrome will be mainly due to histotoxic factors in epileptic brain damage.

Adult↗