Symposium: the hemiplegic patient. IV. Increasing functional capacities.

Proprioceptive facilitation (PF) is a phenomenon occasionally seen during motor restoration following acute hemiplegia. At an early stage of recovery, a number of brief passive muscle stretches can facilitate voluntary contraction in the stretched muscles. Here we present a patient who during early recovery from a left hemispheric stroke causing right hemiplegia was able to develop maximum isometric arm force if, during this effort, large-amplitude passive stretches of the elbow were applied as conditioning stimuli. Based on clinical and positron emission tomography findings, possible physiological mechanisms of PF and the role of proprioception in stroke recovery are discussed.

Hemiplegia↗

PubMed2006

Sporadic and familial hemiplegic migraine: diagnosis and treatment.

Hemiplegic migraine is a rare subtype of migraine with aura associated with transient hemiplegia. The weakness is caused by motor aura. Hemiplegic migraine is the only headache syndrome associated with known genetic mutations and serves as a model for understanding more common varieties of migraine. Because the phenotype includes striking yet transient neurological signs and symptoms, it is imperative that clinicians know the differential diagnosis to rule out possible secondary etiologies when treating patients with hemiplegic spells. Hemiplegic migraine occurs with equal prevalence in either a sporadic or familial form differentiated only by family history. Thus far, treatment trials are anecdotal, although verapamil and acetazolamide have shown promise.

Hemiplegia↗

PubMed2005

Deep vein thrombosis and pulmonary embolism in an ambulatory chronic stroke patient.

PURPOSE: Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acute stroke patients. Immobility in stroke patients increases the risk of DVT and pulmonary embolism (PE). The incidence of DVT in non-ambulatory stroke patients is more frequent than the incidence in ambulatory stroke patients. We report a case of DVT and PE in an ambulatory chronic stroke patient. METHOD: Initial physical examination showed heat and swelling of hemiplegic leg. The patient was only able to ambulate with the assist of a monocane and a plastic leaf spring orthosis due to ankle dorsiflexor weakness. The patient was treated with anticoagulation and inferior vena cava filter placement. RESULTS: After long-term anticoagulation, follow-up studies revealed satisfactory resolution of DVT and PE. CONCLUSIONS: We present a case of DVT and PE which developed during the chronic stage of stroke, 2 years from the onset of stroke, and review the cause of DVT.

Hemiplegia↗