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At least 19 recordsLinked to original sources
PubMed1987

Sensory aprosodia with left hemiparesis from subcortical infarction. Right hemisphere analogue of sensory-type aphasia with right hemiparesis?

We report a case of sensory aprosodia with left hemiparesis following an ischemic infarction of the right thalamus and posterior limb of the internal capsule. Bedside evaluation, confirmed by special quantitative tests, demonstrated normal spontaneous affective prosody and gesturing with marked impairment of affective repetition and comprehension of affective prosody and gestures. A left hemiparesis with sensory loss was also present. This combination of deficits appears to represent the right-side analog to the unusual syndrome of Wernicke-type aphasia with right hemiparesis occasionally observed following left subcortical injury, thus providing further support for the hypothesis that the functional-anatomic organization of affective language in the right hemisphere mirrors that of propositional language in the left.

Auditory Perception↗
PubMed1993

Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis.

We investigated the types of syndrome, location, size and presumed causes of 72 patients with acute capsular lacunar infarction. Clinical syndromes were classified into pure motor hemiparesis (PM), sensorimotor stroke (SM) and ataxic hemiparesis (AH). Lesion sizes of AH were significantly smaller than those of PM (p < 0.01) or SM (p < 0.01). When the lesion volume was classified into two groups, > or = 1 ml and < 1 ml, the large volume group had more frequent cardioembolic sources than the small volume group (41% and 18% respectively, p < 0.05). In AH patients no cardioembolic sources could be detected. Significant carotid stenosis was found in only 4% of patients. Patients with anterior choroidal artery territory infarction had infrequent cardioembolic sources (7%). The results suggest that the lesion size varies with clinical syndrome and some etiological trends are seen in the volume and the location of lesions.

Aged↗
PubMed1991

Ataxic hemiparesis due to small semioval center infarction--consideration of the neuroanatomical disruptions responsible for ataxic hemiparesis.

A 63-year-old man with clinical features of typical ataxic hemiparesis is reported. CT scan and magnetic resonance imaging showed a small infarction in the contralateral semioval center near the parietal cortex. Of note is the previously unreported site of the lesion relative to this syndrome. The neuroanatomical basis for the ataxic hemiparesis syndrome is discussed.

Ataxia↗
PubMed1993

Acute hemiparesis with hemichorea and crossed hemiparesis; unusual presentation for myasthenia gravis.

Myasthenia gravis is an autoimmune disease mediated by antibodies directed against the acetylcholine receptor. Patients typically present with weakness and fatiguability involving predominantly ocular and bulbar muscles. We describe 2 patients with acute weakness, one with a left hemiparetic pattern and chorea, and the other with crossed left hemiparesis and right facial weakness. More typical features of generalised myasthenia developed with time and both had thymic follicular hyperplasia on thymic histopathology. Clinical improvement occurred in both following thymectomy and immunosuppression. These cases exemplify the fact that markedly asymmetric limb weakness can be an early feature of generalised myasthenia gravis.

Acute Disease↗
PubMed2005

Magnetic resonance image correlates of hemiparesis after neonatal and childhood middle cerebral artery stroke.

OBJECTIVE: Motor impairment after neonatal and childhood-onset ischemic stroke (IS) is common, although the prevalence and type of hemiparesis differs between the 2 age groups. Lesion topography is an important predictor of hemiparesis after neonatal IS, but it is not known if the same topographic predictors of adverse motor outcome apply to childhood-onset IS. We used a consistent approach to define lesion topography and evaluate motor outcome in both age groups to (1) investigate whether early topographic predictors of hemiparesis after unilateral middle cerebral artery-territory stroke are the same in neonates and older children and (2) compare the prevalence of dystonia and loss of independent finger movements between the 2 age groups. DESIGN: Twenty-eight patients with neonatal-onset IS (Hammersmith Hospital, London, United Kingdom) were studied together with 43 patients with childhood-onset IS (Great Ormond Street Hospital, London, United Kingdom). All patients had exclusive unilateral middle cerebral artery-territory IS. Lesion topography was studied by using the first magnetic resonance image acquired after the onset of symptoms and was coded for involvement of cerebral cortex (CC), posterior limb of the internal capsule (PLIC), basal ganglia (BG), and white matter. The primary outcome was hemiparesis, and secondary outcomes were dystonia and loss of age-appropriate independent finger movements. RESULTS: Hemiparesis was more common after childhood-onset IS (56%) than neonatal-onset IS (24%). In neonatal-onset IS, concomitant involvement of BG, CC, and PLIC predicts the development of hemiparesis (odds ratio: 99; 95% confidence interval: 5.2-1883.8), and no child with 1 or 2 of these structures involved developed hemiparesis. In contrast, in childhood-onset IS, concomitant BG, CC, and PLIC lesions tended to be associated with hemiparesis (9 of 11), but this adverse outcome was seen also among patients with 1- or 2-site involvement. However, hemiparesis was less likely if the infarction involved BG only (odds ratio: 0.162; 95% confidence interval: 0.036-0.729). Dystonia was present in 15 of 24 in the childhood-onset group with hemiparesis but was not seen after neonatal-onset IS. In both age groups upper-limb impairment was more severe than lower-limb impairment, with frequent loss of independent hand function among hemiparetic patients. CONCLUSIONS: In neonatal and childhood-onset IS, early magnetic resonance imaging provides useful prognostic information about subsequent motor outcome. There are differences in the functional response of the neuromotor system to injury between the 2 age groups that cannot be attributed to methodological differences alone.

Adolescent↗
PubMed1992

[The early hemiparesis of stroke in evolution of basilar artery--case report].

In basilar artery thrombosis, hemiparesis without obvious brainstem signs may precede the tetraplegia with coma or a locked-in state. This premonitory hemiparesis was called as "herald hemiparesis" by Fisher (1988). Its early detection is important because immediate anticoagulant therapy may prevent its evolution. We reported two patients with such hemiparesis. The first case was a 71-year-old diabetic and hypertensive man who was admitted because of right hemiparesis, dysarthria and decreased spontaneous speech. Initially, his symptoms looked like those of a left cerebral lesion. CT scans revealed no fresh cerebrovascular lesion. A few hours later, a myoclonic movement appeared in his left lower limb, and right MLF syndrome developed. We thought he had basilar artery thrombosis and we started intravenous administration of heparin. But he developed tetraplegia with locked-in state. The second case was a 76-year-old diabetic and hypertensive man with a confusional state, right hemiparesis, dysarthria and conjugate gaze deviation to left. After admission, he rapidly became comatose and developed respiratory arrest. CT scans revealed low density areas in the brainstem, cerebellum and the occipital lobe. He died ten days later. Early detection of herald hemiparesis is by no means easy. However, severe dysarthria and myoclonic jerks in a patient with hemiparesis should be considered as warning signs to indicate the herald hemiparesis with subsequent severe brainstem infarction.

Aged↗
PubMed1990

Relation of regional cerebral blood flow to hemiparesis in chronic subdural hematoma.

To investigate the causative mechanism of hemiparesis in chronic subdural hematoma, 38 patients with unilateral chronic subdural hematoma were studied on the relationship between their clinical manifestations and regional cerebral blood flow measured with 133xenon inhalation (16 detectors on each side of the head, Initial Slope Index). Twenty-five patients with hemiparesis (hemiparesis group) and 13 patients with headaches only and without any neurological deficits (headache group) were examined before surgery for chronic subdural hematoma. Among the hemiparesis patients, 15 were examined after surgery. Preoperative regional cerebral blood flow values in the headache group were normal in all regions bilaterally and showed no significant regional difference in one hemisphere or interhemispheric difference between the corresponding regions in both hemispheres, whereas preoperative regional cerebral blood flow values in the hemiparesis group were generally around the lower limit of the age-matched normal value and were subnormal in some areas, and the regional cerebral blood flow values were significantly lower on the hematoma side than on the intact side in most regions. The rolandic region especially showed the lowest regional cerebral blood flow value of 32.3 in the Initial Slope Index on average and the most significant interhemispheric differences of regional cerebral blood flow. Such a preoperative reduction of regional cerebral blood flow in the hemiparesis group normalized along with clinical improvement after evacuation of the hematoma. It was suggested that localized cerebral blood flow reduction at the rolandic cortical region under the hematoma might be one of the causative factors of hemiparesis in chronic subdural hematoma.

Adult↗
PubMed2004

[Clinical study of 23 patients with ataxic hemiparesis].

BACKGROUND AND OBJECTIVE: To characterize the clinical features, etiology and prognosis in ataxic hemiparesis syndrome. PATIENTS AND METHOD: Descriptive study of 23 patients with ataxic hemiparesis included in the Sagrat Cor Hospital of Barcelona Stroke Registry over a 12 year period. RESULTS: Ataxic hemiparesis was caused by a lacunar infarct in 87% of patients, by atherothrombotic infarcts in 8.7% and by cardioembolic infarct in 4.3%. Ataxic hemiparesis accounted for 0.9% of all acute strokes (n = 2,500), 1.25% of all cerebral infarcts (n = 1,840), and 4.1% of all lacunar infarcts (n = 484). Internal capsule (22%), pons (13%), and corona radiata involvement (9%) were the most frequent cerebral topographies. Absence of in hospital mortality and absence of neurological deficit at discharge from the hospital were present in 39% of the patients. CONCLUSIONS: Lacune hypothesis is present in ataxic hemiparesis syndrome. Ataxic hemiparesis is caused by a lacunar infarct in 87% of patients. The internal capsule topography is the most frequent and the prognosis in ataxic hemiparesis is good.

Aged↗
PubMedDate not supplied

Somatosensory evoked potentials in lacunar syndromes of pure motor and ataxic hemiparesis.

Syndromes of hemiparetic lacunar infarction include pure motor hemiparesis and ataxic hemiparesis. Twelve such patients were evaluated with somatosensory evoked potentials. Potentials were delayed or absent in all 4 patients with ataxic hemiparesis and in 1 of 8 patients with pure motor hemiparesis. Unlike pure motor hemiparesis, ataxic hemiparesis appears to be associated with abnormal somatosensory evoked potentials. These abnormalities suggest that disturbance of afferent pathways are important in ataxic hemiparesis.

Afferent Pathways↗
PubMed1991

[Pathogenesis of ipsilateral hemiparesis in patients with lateral medullary syndrome].

Lateral medullary syndrome is known to cause hemiparesis ipsilateral to the medullary lesion. However, it's clinical significance has not been fully evaluated. In this study, we made clinical and angiographic studies in patients with syndrome to elucidate the pathogenesis of ipsilateral hemiparesis. Thirty-four patients with cerebral infarction presenting with this syndrome were studied. Their mean age was 51 years and all the patients were examined within 6 months of their first attack. Diagnosis of ipsilateral hemiparesis was made if subjective feeling of weakness in the upper and lower extremities was associated with increased deep tendon reflexes. Ipsilateral hemiparesis was observed in 38% of all the patients. Cerebral angiography was performed in 26 patients and divided into two groups; group A with ipsilateral hemiparesis (n = 9) and group B without ipsilateral hemiparesis (n = 7). In 56% of patients in group A, angiography showed non-visualization of ipsilateral vertebral artery (VA) and posterior inferior cerebellar artery (PICA). Non-visualization of these two arteries never occurred in the patients of group B. On the other hand, non-visualization of VA alone was observed in 35% of the patients in group B, but it was none in the patients of group A. However, there were no differences in concerning the frequency of non-visualization of PICA alone or non-occlusion at all between both groups. Therefore, the focal ischemia in the region below the pyramidal decussation due to the occlusion of both VA and PICA, regardless of thrombotic or embolic episode, was considered to be responsible for ipsilateral hemiparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Facial sparing as a feature of prenatal-onset hemiparesis.

The presence of facial weakness was prospectively correlated with age of onset of hemiparesis. Facial weakness was not associated with prenatal-onset hemiparesis, but sometimes occurred with onset of hemiparesis during the first year of life. In contrast, facial weakness was generally present when all patients with postnatal-onset hemiparesis were considered as a group. With double hemiparesis, facial weakness was common, regardless of age at onset. These findings suggest that facial sparing results from plasticity of the developing corticobulbar tract, the critical period ending during the first year of life. Decreased synapse elimination of uninjured, ipsilateral terminals is suggested as the mechanism of facial sparing. Facial weakness accompanying double hemiparesis thus would be a reflection of absence of an uninjured pathway.

Aging↗
PubMed2006

Neuroimaging abnormalities in infants with congenital hemiparesis.

Clinical and neuroimaging characteristics of congenital hemiparesis were examined in a retrospective cohort study nested within 199,176 births within the Kaiser Permanente Medical Care Program, 1997-2002. Infants with a physician diagnosis of paresis or cerebral palsy were electronically identified, and charts were reviewed to confirm congenital hemiparesis. A neuroradiologist reviewed available head MRI and CT scans. Of 96 infants with congenital hemiparesis (population prevalence 4.8 per 10,000), 81% received either a head magnetic resonance imaging (n = 55) or head computed tomography only (n = 23). Perinatal arterial infarction was the most common (30%) neuroimaging finding in term infants. Infants with right-sided hemiparesis (relative risk 4.6, 95% confidence interval 1.4-14.4) or moderate to severe weakness (relative risk 4.4, 95% confidence interval 1.1-17.7) were more likely to have had a perinatal arterial infarction. Periventricular white matter lesions predominated in preterm infants (71%). Brain malformations observed in 14 (18%) patients included polymicrogyria, heterotopia, and schizencephaly. The 14 infants (18%) with a normal head imaging study were more likely to outgrow all signs of hemiparesis by age 3 than were infants with an abnormal brain image (29% vs 0%, P < 0.001). Neuroimaging studies provide useful diagnostic and prognostic information in infants with congenital hemiparesis.

Brain↗
PubMed2003

Aspects of joint coordination are preserved during pointing in persons with post-stroke hemiparesis.

Understanding the fundamental deficits that underlie abnormal reaching movements in persons with hemiparesis is important to the development of rehabilitation approaches for these persons. The purpose of the present study was to investigate whether, and to what extent, persons with hemiparesis retain the ability to exploit motor abundance to coordinate their joint motions to control the hand's path during reaching--a general feature of joint coordination in age-matched control persons. Eight subjects with mild to moderate right hemiparesis following a stroke and seven age and gender matched control subjects performed pointing movements with each arm individually to targets in the contralateral and ipsilateral workspaces. Ten joint motions and characteristics of hand movement were measured over multiple repetitions. The variance (across trials) of joint combinations was partitioned into two components at every point in the hand's trajectory; joint variance that led to a consistent hand position and joint variance that led to an inconsistent hand position from trial to trial. All participants were able to limit joint configurations that would have led to trial-to-trial variance of the hand's path, while using a range of joint configurations consistent with a stable hand path. These results demonstrate that persons with mild to moderate hemiparesis and no measured sensory or perceptual deficits utilized available motor abundance to stabilize performance variables that were important to successful completion of a reaching task, just as was found for age-matched control persons. A principal components analysis of joint angle variance across several points in the movement cycle demonstrated that the persons with hemiparesis showed different patterns of joint couplings during reaching compared with the age-matched control persons; this was particularly evident for the more impaired individuals. These findings were related to the two features of synergy as proposed by other workers. It is suggested that these results support the idea that, while subjects with mild-to-moderate hemiparesis demonstrate differences in the feature of a synergy related to the specific patterns of joint coupling, they retain the feature of a synergy that is related to error compensation.

Aged↗
PubMed2005

Incidence and diagnosis of anosognosia for hemiparesis revisited.

BACKGROUND: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis. OBJECTIVE: To determine whether this wide variation might be explained by the different criteria used for diagnosing anosognosia. METHODS: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for hemiparesis using the anosognosia scale of Bisiach et al. RESULTS: 94% of the patients who were rated as having "mild anosognosia"-that is, they did not acknowledge their hemiparesis spontaneously following a general question about their complaints-suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. However, they immediately acknowledged their paresis when they were asked about the strength of their limbs. Their other deficits clearly had a greater impact. These patients had significantly milder paresis than those who denied their disorder even when asked directly about their limbs. CONCLUSIONS: Patients who do not mention their paresis spontaneously but do so when questioned about it directly should not be diagnosed having "anosognosia." If this more conservative cut off criterion is applied to the data of the present as well as previous studies, a frequency of between 10% and 18% for anosognosia for hemiparesis is obtained in unselected samples of acute hemiparetic stroke patients. The incidence thus seems smaller than previously assumed.

Adult↗
PubMed1997

Global aphasia-with and without hemiparesis. A linguistic and CT scan study.

The location and size of brain lesions were compared between two groups of patients showing persisting global aphasia according to the criteria of the Aachen Aphasia test (AAT). The first group comprised 8 patients suffering from severe hemiparesis for more than 18 months. The 10 patients of the second group showed either no hemiparesis at all, or motor disturbance at the onset of the disorder with complete remission within 1 year. The sizes of the brain lesions were determined by means of CT scans. The location of the lesions was defined by a statistical model of the brain with labelled anatomical structure, which allowed an interindividual comparison. In the CT scans, the infarcted areas of the brains of patients with hemiparesis always extended to the wall of the lateral ventricle, thus including the whole corona radiata with the pyramidal tract. The infarcted areas of the patients without hemiparesis and with transient hemiparesis spared parts of the deep white matter. The data obtained via CT scans are of prognostic value for patients with transient hemiparesis, since determination of the extent of the lesion by means of CT permits an initial estimate on the possible later degree and quality of the motor recovery.

Aphasia↗
PubMed2005

Profile of pediatric hemiparesis.

Our objective was to determine the clinical spectrum of pediatric hemiparesis by identifying the relative frequency of various diagnoses and comorbid conditions seen in these children. Case records of all patients with hemiparesis in a single practice over an 11-year period were reviewed with reference to clinical features, etiologic determination, and comorbid conditions. Ninety-two children were identified: 73 (79.3%) had a congenital hemiparesis and 19 (20.7%) had an acquired hemiparesis. An abnormal perinatal history (P = .003), prematurity (P = .016), and younger age at onset of symptoms (P < .001) were associated with a congenital hemiparesis. The overall etiologic yield was 83.7% (82.2% in the congenital and 89.5% in the acquired). The top four etiologic entities were cerebrovascular ischemia (40.2%), periventricular leukomalacia (18.5%), intracranial hemorrhage (16.3%), and cerebral dysgenesis (13%). Factors predictive of establishing an underlying etiology included birth prior to 34 weeks' gestation (P = .034), global developmental delay (P = .048), epilepsy (P = .024), and having appropriate imaging modalities (P = .001). Half of these children had a concurrent global developmental delay, associated epilepsy (odds ratio 3.67; 95% confidence interval 1.40-9.72), and prematurity (odds ratio 5.41; 95% confidence interval 1.56-18.80). A third of these children developed epilepsy. Multivariate predictive factors for epilepsy included global developmental delay (odds ratio 4.20; 95% confidence interval 1.44-12.27), cerebrovascular ischemia (odds ratio 5.10; 95% confidence interval 1.76-14.77), and term birth (odds ratio 3.87; 95% confidence interval 1.20-12.56). The majority of children with hemiparesis have a congenital etiology. The diagnostic yield is higher than previously reported; however, specific underlying etiologies need to be better determined. Comorbid conditions of global developmental delay and epilepsy have a high prevalence in this population, contributing to overall morbidity.

Adolescent↗
PubMed2003

The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions.

BACKGROUND AND PURPOSE: Standard and quad canes are often prescribed to patients with hemiparesis, yet their effect on postural control remains unclear. Thus, the objective of this study was to examine the effects of standard and quad canes on postural sway and on weight-bearing patterns in patients with hemiparesis. SUBJECTS: Thirty subjects with a diagnosis of unilateral hemiparesis following a stroke (patient group; mean age=71.2 years, SD=7.0) and 20 age-matched, community-dwelling volunteers without hemiparesis (comparison group; mean age=72.1 years, SD=5.2) participated in the study. METHODS: Postural sway and percentage of body weight (%BW) borne by each extremity were measured in 3 positions: with the heels aligned with each other (aligned position) and in staggered foot positions with either the affected or unaffected extremity placed forward (affected FW and unaffected FW positions). All subjects were tested in each position with no cane, a standard cane, and a quad cane. The order of tests was randomized, and analysis of data included use of an analysis of variance and adjusted Tukey-Kramer tests. RESULTS: In both the aligned and unaffected FW positions, postural sway was reduced only with the quad cane. Both types of canes reduced postural sway in the affected FW position; however, the quad cane had a greater effect. An asymmetrical weight distribution between the lower extremities did not change in the patient group across positions, even with walking aids. DISCUSSION AND CONCLUSION: A quad cane appears to be more effective than a standard cane in decreasing postural sway in patients with moderate impairment secondary to hemiparesis during stance. The greatest effect on postural sway occurred when the assistive device was contralateral to the foot placed forward. The use of a cane does not appear to adversely affect the asymmetrical weight-bearing pattern during stance that is characteristic of patients with hemiparesis, even when balance is challenged by decreasing the base of support.

Aged↗