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PubMed1997

Facilitation of ipsilateral motor pathways during recovery from hemiplegia in two adolescent patients.

In two hemiplegic patients with acquired cerebral lesions, transcranial magnetic stimulation (TMS) was carried out to examine the contribution of the ipsilateral motor pathways to recovery from hemiplegia. A 13-year-old girl (patient 1) had acute hemiplegia due to a rupture of an arteriovenous malformation, and a 13-year-old boy (patient 2) had subacute hemiplegia due to a brain tumour. They showed complete upper limb palsy but recovered after therapy; patient 1 had slightly disabled motor function of the arm, and patient 2 recovered completely. Motor evoked potentials (MEPs) were recorded from the biceps brachii muscles on both sides. The MEPs of the paretic biceps were only elicited by TMS of the intact hemisphere at the beginning of recovery from hemiplegia, but not by TMS of the affected hemisphere. The MEP amplitudes increased and cortical representation areas for the paretic biceps by TMS were enlarged temporarily during recovery. They regressed in patient 1 and MEPs were not evoked at all in patient 2 after recovery. Conversely, MEPs were obtained by TMS of the affected hemisphere after recovery in both patients. These data indicate that ipsilateral motor pathways play a role in recovery from hemiplegia, especially at the beginning, and become inactivated when the contralateral motor pathways recover.

Adolescent↗
PubMed2002

Effect of an arm sling on gait pattern in patients with hemiplegia.

OBJECTIVE: To investigate the effect of an arm sling on gait patterns of patients with hemiplegia. DESIGN: Crossover design of 3-dimensional gait analysis and concomitant video recordings performed during a single session. SETTING: Rehabilitation ward gait laboratory of a university hospital. PARTICIPANTS: Thirty-one patients (20 men, 11 women) with hemiplegia with an average age of 53.1+/-9.7 years and 31 age-, sex-, height-, and weight-matched able-bodied persons. INTERVENTIONS: All patients with hemiplegia and able-bodied controls walked at self-selected speed over a 10-m walkway, either with or without an arm sling. MAIN OUTCOME MEASURES: Time-distance, kinematic, and kinetic parameters of gait. RESULTS: The able-bodied group did not show any difference in gait parameters while using the sling. However, in patients with hemiplegia wearing a sling, walking speed and stance period of the paretic side increased, double support time of the paretic side decreased, excursion of the center of gravity (COG) decreased, and weight bearing of the paretic side increased. CONCLUSIONS: An arm sling improved gait, especially during gait training sessions of patients with hemiplegia who have impaired body image and excessive motion of the COG.

Ankle Joint↗
PubMed2002

The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia.

OBJECTIVE: To determine the effect of altering the foot placement of the dominant limb in young healthy subjects and the uninvolved limb of subjects with hemiplegia on their ability to perform sit to stand (STS). DESIGN: Controlled biomechanical experiment. SETTING: Research laboratory of a university health science center. PARTICIPANTS: Nonrandom convenience sample of 10 healthy and 10 subjects with hemiplegia. Respective mean ages were 26 and 59 years. All patients with hemiplegia could ambulate and STS independently. The mean time since the stroke was 3.6 years. INTERVENTIONS: Subjects came from a sitting to a standing position under 3 different conditions: (1) normal condition, where both limbs were placed in 100 degrees of knee flexion; (2) limb extended condition, where the dominant or uninvolved limb was extended to 75 degrees of knee flexion; and (3) limb elevated condition, where the dominant or uninvolved limb was placed on a dense foam support equal to 25% of the subject's knee height. MAIN OUTCOME MEASURES: Vertical and anteroposterior ground reaction forces (GRFs) and bilateral tibialis anterior and quadriceps electromyogram (EMG) activity. RESULTS: In the young subjects, the normally placed nondominant limb compensated for the extended or elevated position of the dominant limb. Peak GRFs and EMG amplitudes were all significantly greater for the nondominant limb. In patients with hemiplegia, the EMG of the involved limb increased 39% in the limb-elevated and -extended conditions compared with the normal condition. Respective values for the uninvolved limb decreased. GRFs were significantly greater for the uninvolved limb except for the vertical force in the limb-extended position. CONCLUSIONS: Muscle activity and GRFs can be influenced by altering the initial foot placement of the dominant or uninvolved limb during STS. These initial data have positive implications for the rehabilitation of patients with hemiplegia who could be taught to overcome a reduced ability to use their impaired limb after stroke.

Adolescent↗
PubMed1999

Asymmetrical myelination of the posterior limb of the internal capsule in infants with periventricular haemorrhagic infarction: an early predictor of hemiplegia.

AIM: To prospectively assess the predictive value of asymmetrical myelination on MRI of the posterior limb of the internal capsule (PLIC) in newborn infants with an intraventricular haemorrhage (IVH) associated with unilateral haemorrhagic parenchymal involvement (PI), for subsequent development of a hemiplegia. METHODS: 12 preterm infants (GA 25-36 wks) and 4 full-term infants were studied. Using cranial ultrasound (US), the pre-term infants were diagnosed to have an IVH with unilateral PI. The term infants presented with a porencephalic cyst (PC) on the first postnatal US, following an antenatal IVH with PI. MRI was performed at 40 wks postmenstrual age in the pre-term infants and during the first 2 weeks of life in the full-term infants, using a 1.5T magnet. Using an inversion recovery sequence, the myelination of the internal capsule was recorded as normal, abnormal or equivocal. Neurological assessment > or = 12 months disclosed the presence of a hemiplegia or asymmetry in tone pattern. RESULTS: All 4 cases with a normal internal capsule had a normal outcome in spite of the development of a PC. All 9 cases with an abnormal PLIC developed a hemiplegia, while 1 of the 3 cases with an equivocal PLIC is normal on neurological assessment, one developed a mild asymmetry in tone and 1 a mild hemiplegia. CONCLUSION: While a symmetrical signal intensity within the internal capsule on MRI, performed at 40 weeks PMA, in infants with an IVH and unilateral PI appears to be strongly related to a normal outcome, an asymmetrical PLIC is an early predictor of future hemiplegia.

Cerebral Infarction↗
PubMedDate not supplied

Assessment of upper limb function in hemiplegia by measuring transcutaneous oxygen tension.

To investigate whether the noninvasive determination of transcutaneous oxygen tension (TcO2) can be used to evaluate the degree of hemiplegia, we measured TcO2 before and after a 2-mo rehabilitation course in 12 patients with hemiplegia caused by cerebrovascular diseases. All patients with no evidence of heart failure (ejection fraction evaluated by echocardiogram: 68.7 +/- 6.4%) began to receive conventional physical therapy a few days after the onset of stroke. The measurement of TcO2 was performed at 9:00 a.m. with an electrode placed on the skin surface of the flexion side of the forearm 5 cm distal to the elbow. Before rehabilitation, the difference in TcO2 between the paralyzed and healthy upper limbs ((delta)TcO2) in patients at Brunnstrom's stage V was significantly lower than that in patients at stages II, III, and IV (P < 0.05, P <0.01, and P < 0.01, respectively). After rehabilitation, (delta)TcO2 in patients at Brunnstrom's stage V was significantly lower than that in patients at stage III(P < 0.05). The (delta)TcO2 in the patients with severe hemiplegia was larger than that in patients with slight hemiplegia. In addition, TcO2 at the paralyzed upper limb increased significantly after rehabilitation (before 62.7 +/- 10.5 mm Hg; after 71.9 +/- 9.0 mm Hg; P < 0.05), although arterial blood oxygen tension (PaO2) did not. Therefore, the TcO2 determination may be useful in assessing the degree of hemiplegia in upper limbs.

Aged↗
PubMed2002

Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water.

OBJECTIVE: To evaluate bacterial flora in hemiplegic hands as a possible pathogen of endogenous infection in a rehabilitation unit and to examine the effect of cleansing hands with acidic mineral water on the flora. DESIGN: Case-control study in a university affiliated hospital. Seventy-two patients with hemiplegia caused by cerebrovascular diseases were included in this study. Bacterial flora by the swab method, bacterial frequency on the palm by the stamp method, and skin surface pH were examined before and after single cleansing by immersion in plain or acidic mineral water. RESULTS: The bacterial frequencies of patients with hemiplegia and diabetes were higher than those of normal healthy subjects. After cleansing with acidic mineral water, skin surface pH was decreased and bacterial frequency was markedly decreased. A prolonged decrease in skin surface pH was observed in patients with hemiplegia in contrast to normal healthy subjects who presented a short-term decrease. CONCLUSION: Increased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

Adolescent↗
PubMed1991

Tactile extinction in childhood hemiplegia.

Tactile extinction was investigated by the Quality Extinction Test (QET) of Schwartz in 39 patients, 34 of whom had congenital hemiplegia and five early-acquired hemiplegia. Extinction values were significantly higher in hemiplegia patients than in controls and usually contralateral to the side of brain damage, except for four cases with right hemiplegia. Values were also higher in males than in females. There were no significant differences between patients with left and right hemiplegia, and no correlations between extinction and IQ or the presence of epilepsy. There was a correlation between QET scores and neuroradiologically proven cerebral atrophy. The meaning of extinction in hemiplegic patients and the principal theories regarding the pathogenesis of neglect are discussed.

Adolescent↗
PubMed1992

A syndrome of autosomal dominant alternating hemiplegia: clinical presentation mimicking intractable epilepsy; chromosomal studies; and physiologic investigations.

We report the familial occurrence and apparent autosomal dominant inheritance of alternating hemiplegia of childhood. The proband, a 9-year-old boy, presented with developmental retardation, rare tonic-clonic seizures, and frequent episodes of flaccid alternating hemiplegia that had been presumed to represent postictal paralysis. The hemiplegia spells, which started in his first year, did not respond to multiple antiepileptics. Between attacks, there was choreoathetosis and dystonic posturing. Father, brother, paternal uncle, and paternal grandmother had similar histories of alternating hemiplegia. Investigations included negative CT, metabolic, and coagulation studies. EEG and SPECT 99mTc exametazime scanning failed to reveal any significant slowing or any major changes in cortical perfusion during hemiplegia as compared with nonhemiplegic periods. The karyotype revealed a balanced reciprocal translocation, 46,XY,t(3;9)(p26;q34) in the patient, in all the affected living relatives, and in one apparently unaffected sibling. The asymptomatic mother had a normal karyotype. Analysis of DNA markers was consistent with the karyotype results. Both affected siblings were treated with and responded to flunarizine therapy, with a greater than 70% decrease in attack frequency. Documented flunarizine trough serum concentrations were 28.9 ng/ml in the proband and 6.6 ng/ml in his brother.

Adult↗
PubMed1995

Dissociation of anosognosia for hemiplegia and aphasia during left-hemisphere anesthesia.

The stroke literature indicates that the explicit denial of hemiplegia, a form of anosognosia, is associated more commonly with right- than left-hemisphere lesions. Some investigators have suggested that this asymmetry may be an artifact and that the aphasia that often accompanies left-hemisphere dysfunction may mask some instances of anosognosia. Mechanisms suggested for anosognosia have been either "global" or "modular" in nature. Mechanisms posited in global explanations include psychological denial and general mental deterioration; modular explanations include feedback and feedforward theories. Videotapes of 54 patients with medically intractable seizures who had selective barbiturate anesthesia (Wada test) as part of their evaluation for seizure surgery were assessed for anosognosia of hemiplegia and aphasia after hemispheric anesthesia had worn off. The results suggest that, although aphasia may confound the reported rate of anosognosia for hemiplegia following left-hemisphere dysfunction, the frequency of anosognosia for hemiplegia is still higher with right- than left-side dysfunction. Anosognosia for hemiplegia and aphasia were dissociable, providing support for the postulate that awareness of dysfunction is mediated by a modular system.

Adult↗
PubMed1986

[Increasing incidence of left-sided congenital hemiplegias: indication of an asymmetrical vulnerability in the maturing hemispheres?].

Between 1960 and 1983, 101 patients with congenital hemiplegia were seen at the Cerebral Palsy Center of Berne, Switzerland. During this period the numbers of right hemiplegias decreased simultaneously with the birth rate, while the left hemiplegias showed a significant increase. The known prevalence of right hemiplegias has thus disappeared in favor oft the left side (63% during the first 12.44% during the second 12 years). A continuously sinking perinatal mortality-rate during the observed time suggests an improved survival of children with lesions of the right hemisphere. This hypothesis implies a higher vulnerability of the maturing right hemisphere and could explain the earlier prevalence of right hemiplegias. Possible causes of a hemispheric asymmetry are discussed.

Brain↗
PubMed1987

Hemiplegia and lower extremity amputation: double disability.

A retrospective study of 52 consecutive patients was conducted to determine the influence of certain factors on the ambulatory rehabilitation of patients with hemiplegia and lower extremity amputation. Factors studied included side of hemiplegia, laterality of disability, level of amputation, order of disability (amputation first or hemiplegia first), neuromuscular status, mental status, sex, age. The level of function was defined as independent, limited, or nonambulatory. Of 52 double-disability patients, thirty were fitted with a prosthesis. Eight patients attained independent prosthetic function while 16 patients were limited and six were nonambulatory. Factors such as ipsilateral BK amputation preceding hemiplegia, a good-to-fair neuromuscular status, and an intact mental status have been associated with better functional results. Although producing higher fitting rates, none of these factors has been found in the present study to be associated with statistically higher levels of ambulatory function. A good-to-fair neuromuscular status seemed to be the prime requisite for good ambulation with a prosthesis in a patient with the double disability of amputation and hemiplegia.

Aged↗
PubMed1977

[Tomodensitometric study of cerebral accidents causing acute hemiplegia in children].

Computerized Axial Tomography (C.A.T.) easily distinguishes between the two types of cerebral accident responsible for the two major categories of acute hemiplegia in childhood. 1) In hemiplegias which develop in association with hemiclonic status epilepticus (H. H. and H. H. E. syndromes), in the majority of cases there is an appearance of cortico-sub-cortical atrophy involving the whole hemisphere contralateral to the hemiplegia. This atrophy develops following oedema of the hemisphere which accompanies the initial status epilepticus and which is clearly shown by a very early T.A.C. 2) In congenital or acquired hemiplegias not associated with status epilepticus there is, in most cases, an appearance of cerebral infarction or, very rarely, haemorrhage. It is thus possible, from a physiopathogenic standpoint, to draw a clear distinction between these two major forms of acute infantile hemiplegia. The first (H. H. and H. H. E. syndromes) usually result from hemispheric atrophy which develops in association with a unilateral or predominantly lateral episode of status epilepticus, whilst the second group are usually the result of cerebral infarction.

Adolescent↗
PubMed1994

[Parasagittal white matter shearing injury (so-called gliding contusion): possible radiological evidence of spastic hemiplegia in diffuse axonal injury].

Severe head injury or diffuse axonal injury is frequently associated with spastic hemiplegia/paraplegia. However, the causative lesion has not been well elucidated. Especially, the relationship between the gliding contusion and spastic hemiplegia has not been inferred yet. We have analyzed 6 brain concussion cases and 19 cases of diffuse axonal injury. None of the concussion cases experienced hemiplegia in their courses. Among the 19 cases, 10 were left with persistent and disabling hemiplegia/quadriplegia, whereas 5 showed persistent but mild hemiplegia. Among the 10 cases, one was incapacitated by a brainstem hemorrhage. The remaining 9 cases exhibited, in the parasagittal white matter, small hemorrhagic spots in the acute phase CT, low-density areas in the chronic phase CT, and/or T2 high and T1 low signal lesions in the MRI. In 8 cases, the lesion was in accord with the hemiplegic side, but in one case the low density area was on the ipsilateral side. Two of the 3 cases showing quadriplegia exhibited bilateral parasagittal lesions. None of the 5 mild hemiplegia cases and 10 nonhemiplegia cases showed such abnormality. Superficial brain contusions were found in 17 cases altogether, but they were not at all correlated with the occurrence of hemiplegia. Thus, it was concluded that parasagittal white matter shearing injury or so called gliding contusion could be the manifestation of injury to the corticospinal tract in the corona radiata.

Adolescent↗
PubMed2001

[Hypoglycemic hemiplegia: a report of three cases].

Hemiplegia is a rare complication accompanied with hypoglycemia. We reported three cases of hypoglycemic hemiplegia (HH). Case 1: A 74-year-old female had medication for diabetes mellitus (DM). She had right hemiplegia and aphasia. Case 2: A 72-year-old male had DM, and was admitted to our hospital having loss of consciousness and right hemiplegia. Case 3: An 82-year-old female suffered from consciousness disturbance with tetraplegia, and had left hemiparesis later. She had no DM, but suffered from iatrogenic hypoglycemia. The brain CT of these three cases showed atrophy, and MRI demonstrated multiple infarction. The angiography of case 1 showed the stenosis of bilateral internal carotid artery and the origin of the left vertebral artery. The angiography of case 2 showed severe stenosis of the left internal carotid artery. The cases above had hypoglycemia at admission. The value of the case 1 was 48 mg/dl, case 2 was 35 mg/dl and case 3 was 38 mg/dl. But these symptoms of the three cases disappeared rapidly after glucose infusion. The literature regarding HH was reviewed, and the pathogenesis was discussed. We emphasize the importance of checking blood sugar levels for the emerging patients with hemiplegia, because it is difficult to discriminate by clinical history or neurological findings.

Aged↗
PubMed1997

Focal brain dysfunction in a 41-year old man with familial alternating hemiplegia.

The acute pathophysiologic changes during hemiplegic spells and the long-term outcome of alternating hemiplegia remain obscure. In a 41-year-old male with familial alternating hemiplegia we found an increase in right frontal cerebral blood flow 3 h into a 5-h left hemiplegic episode. A repeat high-resolution brain SPECT study performed 26 h after the resolution of the left hemiplegia revealed normalization of the frontal blood flow accompanied by hyperperfusion in the right parietal lobe. An interictal SPECT scan several weeks later showed no asymmetries. Head CT and MRI scans were negative. Neuropsychologic assessment and neurologic examination revealed evidence of a diffuse disorder which predominantly involved the right hemisphere. To our knowledge, there are no previous correlative studies of serial high-resolution brain SPECT with MRI, or of detailed neuropsychologic assessment, in adult patients with such an advanced course of alternating hemiplegia of childhood.

Adult↗
PubMed1982

Physiological alterations of motor units in hemiplegia.

Isometric contractions of single motor units in the first dorsal interosseous muscle were recorded with an intramuscular microstimulation technique in patients with short- or long-term hemiplegia and compared with controls. In the hemiplegic patients motor units could be classified as in controls, utilizing twitch contraction time and fatigue sensitivity, as FF (fast fatigable), FR (fast fatigue resistant) and S (slow fatigable). The mean twitch contraction time of fast-twitch but not slow-twitch units was slightly prolonged in patients with spastic hemiplegia and motor units, especially type S, tended to generate larger twitch tensions. A fourth type of motor unit, characterized by slow-twitch contraction times and increased fatigability (SF units), was recorded in long-term hemiplegia. The data demonstrate that during long-term spastic hemiplegia in man some motor units develop increased fatigability and prolonged-twitch contraction times, reflecting the dynamic properties of muscle.

Adult↗
PubMed2003

Alternating hemiplegia of childhood: a syndrome inherited with an autosomal dominant trait.

Alternating hemiplegia of childhood is a rare disorder characterized by recurrent attacks of hemiplegia affecting either side of the body, oculomotor and autonomic disturbances, movement disorders, and progressive cognitive impairment. We report on one family with autosomal dominant alternating hemiplegia. The disorder was first recognized in a 9-year-old child, the third son of the family, who presented with learning disability, tonic-clonic seizures, dystonic attacks, and episodes of alternating hemiplegia starting at the age of 2 1/2 years. His mother and three brothers had similar symptoms. The maternal uncle, who has learning disability, had experienced multiple dystonic attacks. Tests performed on the family, including computerized tomography, magnetic resonance imaging, and magnetic resonance angiography of the brain as well as metabolic evaluation, were normal. Cytogenetic analysis was normal and mitochondrial DNA analysis revealed no deletions or mutations in the four affected family members and the grandmother. An autosomal dominant mode of inheritance is suggested by the fact that both sexes are affected in two generations.

Adult↗
PubMed1999

Multiple sclerosis with extensive lesions left hemiplegia, mental dysfunction and retrobulbar neuritis.

Multiple sclerosis (MS) is usually diagnosed on the basis of the typical clinical course, with remission and exacerbation in multiple parts of the central nervous system (CNS). Recently, magnetic resonance imaging (MRI) has made a large contribution to the diagnosis of patients with MS. But it is difficult to make a definite diagnosis due to clinical variability of the disease and variable MRI findings. We report the case of a 26-year-old woman who developed progressive left hemiplegia, mental dysfunction, and had extensive bilateral cerebral white matter lesions diagnosed by brain MRI. Complete recovery from the left hemiplegia followed the use of corticosteroid, and her brain MRI findings also improved after medication. Early in the clinical course it was difficult to differentiate between multiple sclerosis and granulomatous angiitis of the CNS. After recovery from the first episode of left hemiplegia and mental dysfunction, she developed acute visual disturbance five months after her first admission. Readmission followed and her retrobulbar neuritis was successfully treated by methylpredonisolone pulse therapy. In summary, she experienced two episodes of neurological deficit, had left hemiplegia and mental dysfunction associated with multiple lesions in bilateral cerebral white matter in brain MRI, and the left retrobulbar neuritis with delay of P100 by visual evoked potential study. Due to these two episodes we concluded that she had multiple sclerosis. Though the initial diagnosis was difficult, prompt treatment and close follow-up was important, since multiple sclerosis and granulomatous angiitis of the CNS can both recur.

Adult↗