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Electrical stimulation of wrist and fingers for sensory and functional recovery in acute hemiplegia.

OBJECTIVE: To investigate the effects of a short-term electrical stimulation in conjunction with neurodevelopmental exercises on sensory and functional recovery of hemiparetic upper limb in acute stroke patients. DESIGN: Controlled clinical trial with alternate allocation. SETTING: Acute inpatient medical care setting of a university hospital. SUBJECTS: Thirty-six acute stroke patients (18 TENS group; 18 control group) who experienced their first stroke were studied. INTERVENTION: Both groups received 1 h/day neurodevelopmental exercises in accordance with Bobath for 10 days. In addition to exercises the TENS group received electrical stimulation of the wrist and finger extensors for 1 h. MAIN OUTCOME MEASURES: Kinaesthesia and position sense tests, a hand function test and a hand movement scale were performed before and after treatment. RESULTS: Both groups showed considerable improvement in kinaesthesia sense and position sense after treatment. Comparison of the two groups after treatment revealed that this difference was not significant (P> 0.05). Both groups showed improvement in hand movement scores (P< 0.05), whereas hand function improved only in the TENS group (P< 0.05). CONCLUSION: The results of this study indicated that additional stimulation of the hand and fingers leads to an improved sensorimotor outcome immediately after the intervention.

Aged↗

Hereditary nonprogressive athetotic hemiplegia: a new syndrome.

A family with four affected members showed a stereotyped unilateral neurologic deficit. The disorder was characterized in each member by congenital left hemiparesis, with subsequent development of left hemihypoplasia and athetoid posturing of the left hand. Although the proband was initially considered a "cerebral palsy" victim, the autosomal dominant pattern and the stereotyped clinical features in all affected family members suggest a hereditary process. Hereditary factors may be an uncommon cause of static unilateral neurologic motor defects.

Adult↗

Cerebral hemisphere asymmetry in CT and functional recovery from hemiplegia.

Cerebral hemispheric asymmetries were assessed in relation to motor and functional recovery in nine patients with stroke. All were globally aphasic, assuring similar location and extent of lesion. Initial motor and functional ability were appraised from medical records and compared with neurologic and functional outcome. Frontal and occipital hemispheric widths and lengths were determined from CT. Patients were classified into three groups on the basis of mean combined asymmetry for width (typical asymmetry, atypical asymmetry, and equal symmetry). Patients with the most atypical cerebral asymmetries showed greater recovery than patients in other groups. Two patients with atypical mean occipital asymmetry (width) fared best functionally, whereas the patient who showed the greatest motor recovery had the most atypical mean occipital asymmetry (width). Cerebral asymmetries may contribute to recovery after stroke.

Activities of Daily Living↗

Impairment of masticatory function in hemiplegia.

We studied masseter muscle function in 15 hemiplegic patients. Direct motor responses to stimulation of the masseteric nerve were normal. Voluntary activity at maximum strength was reduced on the paretic side. The jaw jerk was symmetric, but facilitation by teeth clenching showed on the nonparetic side only. Masseter silent periods were ill-defined and prolonged in recordings from the paretic side. The second silent period, but not the first, was reduced in size when the paretic side was stimulated, and showed an increased habituation. Though the masticatory nucleus receives bilateral innervation, the contralateral hemisphere exerts a predominant control on voluntary activity and multisynaptic reflexes.

Adult↗

Varicella-zoster virus DNA in CSF and arteries in delayed contralateral hemiplegia: evidence for viral invasion of cerebral arteries.

A 78-year-old woman presented with a right basal ganglia infarct 6 weeks after a left herpes zoster ophthalmicus. MR angiography showed focal segmental stenosis of the proximal segments of the anterior, middle, and posterior cerebral arteries. Varicella DNA was detected in the CSF by polymerase chain reaction (PCR). Treated with dexamethasone and acyclovir without improvement, she died 1 month later. There was focal endarteritis in the left anterior, middle, and posterior cerebral arteries at autopsy. Varicella DNA was detected by PCR of extracts from these vessels but not from the arteries on the right side. This study provides further evidence that the vasculopathy after herpes zoster ophthalmicus results from direct viral invasion of the vessel wall.

Aged↗