[A 66-year-old man with aphasia and right hemiplegia. Swiss cheese-like resolution of left atrial thrombus].
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Electrical stimulation of the supra-orbital nerve induces at the same threshold an early reflex reaction in the ipsilateral orbicular muscle and a delayed bilateral reflex response. These reflex activities are modified bilaterally by unilateral hemispheric lesions. Reactions on the hemiplegic side are reduced in amplitude, unlike the responses on the "healthy side" which are facilitated. Adaptation of the reflexogenous threshold of the delayed responses to repeated stimulation is also irregular; cumulative depression occurs earlier on the hemiplegic side, the responses on the "healthy side", on the other hand, show less habituation or a total absence of it. These electrophysiological findings agree with experimental results concerning the influence of cortical structures on the activity of the nuclei of the brain stem. They also, by analogy with the results of research carried out on the limbs, support the tactile origin of the two constituents of the blink reflex.
A study of nerve conduction velocities in ulnar and peroneal nerves bilaterally in 27 hemiplegic patients revealed a statistically significant slowing in the affected limbs compared with the unaffected limbs, and a slowing of both compared with the standards for completely normal subjects. These results suggest that the upper motor lesion affects the function of the lower motor neuron. Proposed causes include a demonstrated lower skin temperature, a possible atrophic thinning of the fibers and other less plausible factors.
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Constipation is a major problem for institutionalized patients. This prospective study was performed on a population of 152 in-patients of a stroke rehabilitation center. Constipation was defined as less than three stools weekly or the use of laxative medication. Constipation occurred in sixty percent of the patients. The incidence of constipation was not related to age or sex but was strongly related to functional status of patients assessed by Barthel Index (p<0.003). The influence of both brain lesion or reduce activity is evaluated.
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