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Hypoglycemic hemiplegia: a case study.

A 33-year-old man was seen in the emergency room with hypoglycemic hemiparesis of his left side. Hypoglycemic hemiparesis is an underrecognized manifestation of hypoglycemia and can mimic cerebrovascular disease, especially in the elderly. Although this is uncommon, hypoglycemia should be considered a part of the neurologic workup of any patient with a new onset of hemiparesis.

Adult↗
PubMed2003

[Post stroke hemiplegia: lower limb benefit from botulinum toxin (review)].

OBJECTIVE: To clarify the conditions governing the use of botulinum toxin (BTX) for post-stroke lower limb spastic disorders: indications, choice of muscles, doses, and duration of efficacy. METHOD: Review of the international literature using the Medline and the Reedoc data banks. RESULTS: Seven controlled studies were reviewed, including in particular 2 studies vs placebo and one vs phenol, 7 open studies or case series closely related to this topic and 4 open studies partly dedicated to it. The usefulness of BTX for the treatment of equinovarus has been demonstrated. The main muscles to be treated are the soleus, gastrocnemius and tibialis posterior. The treatment proposed for toe clawing is BTX injection into the flexor digitorum longus and flexor hallucis longus, and for great toe permanent extension, injection of the extensor hallucis longus. The quadriceps femoris, the tibialis anterior or the hamstrings have only be treated in isolated cases. When the treatment is effective, its benefit may last for more than 6 months. DISCUSSION: A few controlled trials have demonstrated the efficacy of BTX for post stroke lower limb spasticity. The results of all the controlled and open trials argue in favor of its efficacy, but this still requires more thorough analysis. CONCLUSION: Botulinum toxin has a place together with other local treatments for post-stroke spasticity, but a precise guide to its use, especially its dosage, and it's effectiveness compared to that of other treatments, need further study.

Anti-Dyskinesia Agents↗
PubMed2003

[Post stroke hemiplegia: interest of botulinum toxin injection at the upper limb].

OBJECTIVES: To present data about the effect of botulinum toxin injection on the upper limb of stroke patients. METHODS: We used the Medline data bank. Analysis took into account the international classification of functioning and disability. Important technical or pragmatic points were analysed separately. RESULTS: Botulinum toxin reduces spasticity of the injected muscles, with a mean gain of about 1 point on the Ashworth scale in the 4 to 6 weeks post injection, but with a large variability. This is associated to an increase in the passive range of motion, especially at wrist, and at times to a facilitation of active movements, when they are still possible. Improvement in functional tests is observed when fair proximal and distal motricity persists. Reduction in the dependence in daily living activities has not been shown by group studies. Several patients have an improvement in using the hand for blocking and transporting objects, mainly in a facilitating position (pronation, partial wrist flexion). Comfort of patients and caregivers is more regularly improved. Results are partially predictable; improvement in function is observed in patients with fair distal motricity (extension) and low spasticity, and improvement in comfort in those with severe spasticity and low motricity. CONCLUSION: Further studies are required, on one hand for better assessment of distal functional improvement, on the other hand at earlier phases of the disease.

Activities of Daily Living↗