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PubMedDate not supplied

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. METHODS: This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. RESULTS: The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. CONCLUSIONS: Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

Central Nervous System Bacterial Infections↗
PubMedDate not supplied

Herpes zoster and controlateral hemiplegia in an African patient infected with HIV-1.

One of the neurologic complications of human immunodeficiency virus infection are cerebrovascular accidents. In HIV infected patients, ischemic strokes have been reported secondary to nonbacterial thrombotic endocarditis and cerebral arteritis. We describe an unusual cause of stroke in HIV-1 infection: Herpes Zoster ophtalmicus with contralateral hemiplegia.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Treatment of left laryngeal hemiplegia in standardbreds, using a nerve muscle pedicle graft.

The efficacy of a nerve muscle pedicle (NMP) graft in restoring upper airway function was evaluated in exercising horses with induced left laryngeal hemiplegia. The NMP graft was created from the first cervical nerve and the omohyoideus muscle and transplanted into the left cricoarytenoideus dorsalis muscle. Seven adult Standardbreds were trained to exercise on a treadmill inclined at 6.38 degrees. With the horses at rest and exercising at 4.2 and 7.0 m/s, the following variables were recorded: peak inspiratory and expiratory transupper airway pressures (defined as the pressure difference between a lateral tracheal catheter and a mask catheter), peak inspiratory and expiratory air flow, inspiratory and expiratory impedance, tidal volume, minute ventilation, heart rate, and respiratory frequency. Measurements were made before left recurrent laryngeal neurectomy (LRLN), 28 days after LRLN, and 12, 24, and 52 weeks after the NMP graft (n = 5) or sham operation (n = 2). Before LRLN, exercise increased inspiratory and expiratory air flow and transupper airway pressure, whereas the impedance was unchanged. After LRLN, transupper airway inspiratory pressure and impedance were significantly greater and inspiratory air flow was significantly less than baseline values at 7.0 m/s. The sham operation did not improve airway function. Twelve weeks after insertion of the NMP graft, inspiratory impedance and inspiratory air flow were significantly different (improved) from LRLN values. Twenty-four weeks after insertion of the NMP graft, inspiratory impedance was not significantly different from LRLN values.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Stance duration under sensory conflict conditions in patients with hemiplegia.

Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.

Adult↗
PubMedDate not supplied

[Ophthalmic zoster with contralateral hemiplegia].

Herpes zoster ophthalmicus may be followed several weeks after the appearance of skin changes by contralateral hemiplegia. Local angiitis is the most important cause of the brain ischaemic lesions. Based on the literature, in the present work the clinical, pathological and immunological observations are reviewed.

Brain Ischemia↗
PubMedDate not supplied

[Two cases of ophthalmic zoster follow by hemiplegia].

Two cases of ophthalmic zoster are reported in which several weeks after the appearance of skin changes hemiplegia developed. In one case the clinical course was unfavourable, and on autopsy extensive vasculitis was found in the brain with ischaemic foci situated mainly on the side of zoster. In the second case with favourable outcome CT demonstrated ischaemic foci probably of vascular origin, again on the side of zoster.

Aged↗
PubMed1990

[Right hemiplegia and spatial neglect with apraxia and agraphia without aphasia in a right-handed patient].

A 65 year-old right-handed woman was admitted after the sudden onset of a right dense hemiplegia. C.T. showed a large left infarction in the middle cerebral artery territory. There was a slight anosognosia and neglect of the right space without confusion. She had aprosodia but no aphasia. On the other hand, there was a severe apraxia and all the components of Gerstmann's syndrome were present. This suggests an unusual sattering of hemispheric functional dominances.

Aged↗
PubMed1989

[Herpes zoster ophthalmicus with contralateral hemiplegia].

A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.

Acyclovir↗
PubMed1989

Herpes zoster ophthalmicus, contralateral hemiplegia, and recurrent ocular toxoplasmosis in a patient with acquired immune deficiency syndrome-related complex.

A 42-year-old man presented with herpes zoster ophthalmicus on the right side. He was found to have acquired immune deficiency syndrome-related complex. Two weeks later he developed toxoplasmic retinochoroiditis in the left eye. He also presented later with left hemiplegia, which was probably caused by herpes zoster arteritis. Nine months after the retinal lesion resolved he developed another area of toxoplasmic retinochoroiditis adjacent to the first lesion. Herpes zoster may be the first presentation of acquired immune deficiency syndrome-related complex in a young healthy individual. Ophthalmologists are encountering patients with acquired immune deficiency syndrome who may have multiple organisms as the cause for their ocular infections and this might pose a treatment dilemma. The combination of herpes zoster ophthalmicus and ocular toxoplasmosis in this patient makes this case unusual.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Contralateral hemiplegia in herpes zoster ophthalmicus. Role of temporal artery biopsy.

We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed.

Biopsy↗
PubMed1988

[Ocular herpes zoster with contralateral hemiplegia].

A total of 375 patients with neurologic syndromes of herpes zoster were studied. Ten of them presented, along with the involvement of the first branch of the trigeminal nerve and other cranial nerves, contralateral pyramidal symptomatology. Apart from the typical syndrome of herpes zoster ophthalmicus with contralateral hemiplegia the authors distinguished clinical variants in which contralateral pyramidal symptomatology was associated with acute meningoencephalitis.

Adolescent↗
PubMed1987

Triceps spasticity in traumatic hemiplegia: diagnosis and treatment.

Three patients with adult-acquired hemiplegia are described with the unusual dynamic deformity of spasticity of the triceps muscle. This deformity produces motor imbalance with the triceps overpowering the elbow flexors, thus impeding volitional elbow flexion. The nature of the deformity was defined by electromyography of the muscle groups about the elbow, which demonstrated out-of-phase inhibitory electrical activity of the triceps muscle. Treatment consisted of V-Y lengthening of the triceps muscle to achieve agonist-antagonist motor balance. The operation improved hand placement for all three patients.

Adult↗
PubMed1987

Gait changes in adult onset hemiplegia.

Multiple parameters of gait were evaluated in 50 adult acquired hemiplegic patients and 30 control patients with no history of gait abnormality and no deviation from normal gait by observational analysis. Findings in the hemiplegic group include: 1) increase in the proportion of the gait cycle spent in stance and double-limb support phases in both the normal and affected limb; 2) consistent deviation from normal gait pattern by observation and objective pattern analysis; 3) abnormal phasic activity of specific muscles and muscle groups in the affected limb; and 4) a consistent electrogoniometric deviation from normal joint ankle progression in the affected hip, knee and ankle. These data lend credence to the hypothesis that gait deviation in adult acquired hemiplegia follows a consistent pattern varying with the severity of central nervous system involvement. These data also provide a baseline from which to measure therapeutic intervention in this complex patient population.

Adult↗
PubMed1987

Electromyographically triggered electric muscle stimulation for chronic hemiplegia.

Electromyographically triggered electric muscle stimulation (EMS) was evaluated in combination with conventional treatment in 69 consecutive postcerebrovascular accident outpatients whose onset of hemiplegia was four months to 14 years earlier. Six subjects initially exhibited no residual volitional activity in targeted muscles, and all patients had undergone conventional therapy with little or no functional recovery. Electromyographic (EMG) recordings and EMS directed to prime movers of impaired movements were accomplished by way of skin-surface electrodes. Prescribed treatment (patient compliance was frequently substandard) involved several months of four to five sessions per week, focusing on wrist extension and/or ankle dorsiflexion initially, and often other movements later. During 30 to 300 movement attempts per session, EMGs that exceeded a preset threshold triggered immediate stimulation to force movement completion. Over sessions, patients commonly realized substantially improved increases in voluntary EMG capabilities generally proportionate to the frequency of treatment sessions. Parallel improvements were also found for subjectively scaled functional measures of range-of-motion and ambulation. Motivation was important to success, but side and nature of stroke, age, and poststroke interval were not. Progress often far exceeded that of previous conventional therapy (each patient served as his/her own control). Regarding mechanisms, impaired proprioceptive feedback is considered central to stroke-disrupted sensorimotor control. EMG-triggered EMS is intended to improve brain relearning by reinstating proprioceptive feedback time-locked to each attempted movement. Clinical results were consistent with this theory; further assessment of the new EMG-triggered EMS modality intergrated into conventional treatment regimens seems warranted.

Adult↗
PubMed1987

Hemiplegia--an unusual complication of appendectomy. A case report.

A 12-year-old boy developed complete right hemiplegia and 7th cranial nerve palsy 2 days after laparotomy for a perforated appendix. Full recovery took 2 months. Although it can be accepted that the hemiparesis was not caused by acute appendicitis it is postulated that this unusual association was due either to a septic embolus which lodged in the region of the internal capsule or to a minor cerebrovascular accident.

Appendectomy↗
PubMed1986

Adult-onset hemiplegia: changes in gait after muscle-balancing procedures to correct the equinus deformity.

Fifty-four adult patients with acquired spastic equinus and equinovarus deformity were treated with lengthening of the Achilles tendon, lateral transfer of the anterior tibial tendon, and appropriate muscle releases. All patients had preoperative dynamic electromyography and electrogoniometry performed in order to assist in planning the surgical procedures and to provide a baseline assessment of the dynamic deformities. Preoperatively, the stance and double-support phases of gait were prolonged. Throughout the stance phase, the gait of these patients was characterized by equinus deformity of the ankle, decreased flexion of the knee (hyperextension in the most severely involved patients), and increased flexion of the hip (which also varied with the severity of the equinus deformity of the ankle and hyperextension of the knee). In all patients, the operation was performed at least one year after onset of the hemiplegia. Clinical follow-up at an average of thirty months (range, twenty-four to sixty-two months) showed that the equinus deformity was corrected in all patients and that 59 per cent of them were brace-free. Two patients had a superficial infection that healed uneventfully, and two had pull-out of the tendon that required reoperation. Postoperative analyses of gait, performed at least one year after surgery for twenty-seven of the patients, showed that the stance and double-support phases of gait (which had been prolonged before surgery) approached the findings in normal control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Gait patterns in spastic hemiplegia in children and young adults.

Four homogeneous patterns of gait were defined in forty-six patients who had spastic hemiplegia secondary to cerebral palsy or other neurological disorders by analyzing kinematic data in the sagittal plane and electromyographic data. In Group I (twenty patients) the primary abnormality was a drop foot in the swing phase. The thirteen patients in Group II had a tight heel cord in the stance phase as well as a drop foot in the swing phase. The five patients in Group III also had more proximal involvement (that is, restricted motion of the knee) as well as an equinus deformity of the ankle. In Group IV, the eight patients had, in addition, restricted motion of the hip.

Adolescent↗