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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current demographic trends suggest that the Indian population will survive through the peak years of occurrence of stroke (age 55-65 yr) and stroke-survivors in the elderly with varying degree of residual disability, will be a major medical problem. The available data from community surveys from different regions of India for 'hemiplegia' presumed to be of vascular origin indicate a crude prevalence rate in the range of 200 per 100,000 persons. Thus, the anticipated costs of rehabilitation of stroke-victims will pose enormous socio-economic burden on our meagre health-care resources, similar to what is now faced by industrialised nations in the West. Therefore, prevention of strokes at any age should be our main strategy in national health planning. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15 per cent of the urban population is 'hypertensive' (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many reasons such as patient's compliance in taking medicines and poor follow up in clinical practice that may lead to failure in reducing stroke mortality. In subjects who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin in prevention of stroke is well established. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight, and associated conditions like diabetes mellitus etc., should be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base-stations for these surveys because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.
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PMID:Strokes in the elderly: prevalence, risk factors & the strategies for prevention. 936 65

A 68-year-old man with a 28-year history of non-insulin dependent diabetes mellitus (NIDDM) was admitted to our hospital because of foot gangrene. He had previously suffered from cerebral infarction resulting in right hemiplegia and his right foot was amputated because of right femoral lesion presenting diabetic foot gangrene 5 years previously. The diabetic foot gangrene gradually became worse, although he had received various medications. Then, we attempted to treat the patient with low density lipoprotein (LDL)-apheresis ten times a month. The foot gangrene itself and the local circulation around the gangrene lesion were remarkably improved after treatment with LDL-apheresis. We present here the first case of diabetic foot gangrene improved by LDL-apheresis. LDL-apheresis therapy is anticipated to be a new therapeutic approach for treatment of fatal foot gangrene associated with diabetes mellitus.
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PMID:Clinical trial of low density lipoprotein-apheresis for treatment of diabetic gangrene. 947 47

A 58-year-old male experienced a sudden stroke-like onset of right hemiplegia and numbness of his right upper limb while engaged in his desk-work on April 7, 1997. He had a past history of diabetes mellitus and hyperlipidemia. On admission, he had no fever and the blood pressure was 140/70 mmHg. General physical examination was unremarkable. Neurological examination showed 4/5 strength of his right unilateral extremities and numbness of his right upper limb. Clinical features and computed tomography (CT) without contrast medium at the onset of hemiplegia suggested a stroke. Seven days after admission, his consciousness worsened and body temperature fluctuated between 37 and 38 degrees C. Subsequent Gd-enhanced magnetic resonance (MR) which demonstrated an irregular shaped ring-enhancement lesion and lumbar puncture 9 days after admission was compatible with the diagnosis of brain abscess. Surgical drainage confirmed the presence of brain abscess due to alpha-streptococcus. It improved following surgical drainage and antibiotic therapy with PAPM.BP 2 g/day and PIPC 4 g/day. An afebrile patient of sudden stroke-like onset may be a rarity to be added to the differential diagnosis of brain abscess.
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PMID:[A case of brain abscess accompanied with sudden-onset hemiplegia as initial manifestation]. 988 11

We report a 96-year-old Japanese man who developed a sudden onset of left hemiplegia and coma. He was found to have diabetes mellitus, hypertension, and atrial fibrillation since 1996 with occasional episodes of congestive heart failure. He was otherwise apparently well until July 5 of 1997 when he developed a sudden onset of unresponsiveness and convulsion involving his right hand and was admitted to our hospital. On admission, his BP was 210/120 mmHg, heart rate 76/min and irregular, BT 36.5 degrees C, and Cheyne-Stokes respiration. General medical examination was otherwise unremarkable. Neurologic examination revealed semicoma, conjugated deviation to the right, loss of oculocephalic response, left facial paresis of central type, flaccid left hemiplegia, and bilateral Babinski sign. Pertinent laboratory findings are as follows: BUN 47 mg/dl, creatinine 1.46 mg/dl, GPT 69 IU/l, LDH 1,142 IU/l, and CK 385 IU/l. A chest x-ray film revealed cardiac enlargement and EKG showed left ventricular hypertrophy and atrial fibrillation. Cranial CT scan revealed low density areas involving the right anterior cerebral and the right posterior cerebral artery territories. He was treated with an intravenous osmotic agent and short course of intramuscular steroid. He remained unconscious despite these treatment and developed sudden cardiopulmonary arrest three weeks after the admission. The patient was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had suffered from cerebral embolism of cardiac origin. The cause of the death was ascribed to acute subendocardial myocardial infarction. Most of the participants agreed with this conclusion. Postmortem examination revealed an old subendocardial myocardial infarction involving the posterior septal region and posterolateral wall of the left ventricle. Neuropathologic examination revealed hemorrhagic infarctions involving the territories of the right anterior cerebral, right middle cerebral, right posterior cerebral, and left anterior cerebral arteries. The left A1 portion of the anterior cerebral artery was hypoplastic, and the left pericallosal artery appeared to have been receiving blood supply from the right anterior cerebral artery through the anterior communicating artery. The large arteries in the base showed marked arteriosclerosis; particularly, the initial portion of the right posterior artery showed near complete arteriosclerotic occlusions. These characteristic arterial changes appeared to be the reason why this patient suffered from an extensive infarction from what appeared to have been a single episode of cerebral embolism probably initially involving the right internal carotid artery.
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PMID:[A 96-year-old man with consciousness disturbance, convulsion, and left hemiplegia of acute onset]. 1006 67

Two cases of aspergillosis of the paranasal sinuses are reported. The first case was a 30-year-old man who had a 5-month history of bilateral proptosis. Physical examination revealed nasal polyps in both middle meatus. A skin test for Aspergillus was positive. Laboratory study showed levels of serum IgE and IgE specific for Aspergillus level to be elevated significantly. Computed tomography (CT) and magnetic resonance imaging (MRI) showed pansinusitis with some bone erosion. The patient underwent bilateral Caldwell-Luc procedures and external sinus surgery (frontal, ethmoid and sphenoid sinuses). Histopathological examination showed thin septate hyphae in allergic mucin. The patient is now being treated with sinus irrigation and oral administration of fluconazole and suplatast tosilate. The second case was a 78-year-old man who had a 2-month history of nasal obstruction and a 3-week history of headaches. He also had a history of diabetes mellitus. Physical examination showed swelling of the nasal septum due to abscess. CT showed an abscess in the nasal septum and opacification of the left sphenoid sinus. There was no bone destruction. The patient underwent left sphenoid sinus surgery, and histopathological examination revealed aspergillosis of the sphenoid sinus. He presented with left visual disturbance and blepharoptosis 2 months after surgery. Ocoulusion of the internal carotid artery was revealed by MR angiography and it was thought to be caused by intracranial invasion of aspergillus. Loss of consciousness and right hemiplegia ensued despite antifungal chemotherapy. The patient died about 1 year after the onset of symptoms. Case 1 was thought to involve allergic aspergillus sinusitis, and Case 2 invasive aspergillus sinusitis. We emphasize the significance of headache, diabetes mellitus and lesion in the sphenoid sinus as a sigh of intracranial aspergillus invasion, based on our experience as well as findings reported by other clinicians in the Japanese literature.
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PMID:[Report of two rare cases of fungal sinusitis]. 1038 20

We report a patient with anosognosia for hemiplegia associated with a right pontine infarction. A 51-year-old woman with histories of hypertension and diabetes mellitus was admitted because of weakness of her left upper and lower extremities. On neurologic examination, she was alert and oriented without dementia. Visuospatial hemineglect was not present. Hemiparesis of her left upper and lower extremities was noted. Her brain MRIs showed a large infarction in the right pons. On admission, she could recognize her illness but was indifferent to her hemiplegia, so she said that there was not well-off for her life. Two weeks after the onset, her neurological symptoms gradually improved. Simultaneously, her interest in her hemiparesis increased. We proposed that, in the present patient, anosognosia for hemiplegia was caused by the pontine infarction. Since pontine anosognosia for hemiplegia has been rarely reported to date, it is expected that the findings of the present patient will be useful to the better understanding of mechanisms underlying anosognosia.
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PMID:[Anosognosia for hemiplegia in a patient with pontine infarction]. 1119 47

A 56-year-old woman was hospitalized with a right hemiplegia and aphasia evoking a cerebral infarction. In fact the neurologic deficits were of post-ictal origin, secondary to a partial epilepsy which began a few weeks before, at the same time as a polyuria-polydipsia syndrome revealing diabetes mellitus. This case illustrates the possibility for a partial epilepsy to occur in relation with a nonketotic hyperglycemia. If in most of those cases there is no underlying cortical lesion, in some observations the hyperglycemia is associated with an infarction. In our case the MRI revealed another type of lesion: a cortical dysplasia in form of a unilateral micropolygyria with a perisylvian distribution centered around the insula. The discovery of a cortical dysplasia at such an age is very unusual.
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PMID:[Epileptic seizures, hemiplegia and hyperglycemia: late discovery of a localized cortical dysplasia]. 1145 89

The drugs used to treat diabetes mellitus are diverse and include several classes. One class is sulfonylureas which primarily cause serum glucose reduction by stimulating the release of preformed insulin from the pancreatic islets. Gliclazide, a second generation sulfonylurea, is used to control glycemic levels in non-insulin-dependent diabetes mellitus. We report a 14 year-old non-diabetic girl who developed hepatitis, hemiplegia and dysphasia after ingestion of an overdose of gliclazide (20 mg/kg/day) in a suicide attempt. Our purpose is to draw attention to the severity of gliclazide-induced neurological signs. To the best of our knowledge, gliclazide-induced hemiplegia and dysphasia have not been previously reported in the literature.
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PMID:Gliclazide-induced hepatitis, hemiplegia and dysphasia in a suicide attempt. 1159 75

Hemiplegia is a rare complication accompanied with hypoglycemia. We reported three cases of hypoglycemic hemiplegia (HH). Case 1: A 74-year-old female had medication for diabetes mellitus (DM). She had right hemiplegia and aphasia. Case 2: A 72-year-old male had DM, and was admitted to our hospital having loss of consciousness and right hemiplegia. Case 3: An 82-year-old female suffered from consciousness disturbance with tetraplegia, and had left hemiparesis later. She had no DM, but suffered from iatrogenic hypoglycemia. The brain CT of these three cases showed atrophy, and MRI demonstrated multiple infarction. The angiography of case 1 showed the stenosis of bilateral internal carotid artery and the origin of the left vertebral artery. The angiography of case 2 showed severe stenosis of the left internal carotid artery. The cases above had hypoglycemia at admission. The value of the case 1 was 48 mg/dl, case 2 was 35 mg/dl and case 3 was 38 mg/dl. But these symptoms of the three cases disappeared rapidly after glucose infusion. The literature regarding HH was reviewed, and the pathogenesis was discussed. We emphasize the importance of checking blood sugar levels for the emerging patients with hemiplegia, because it is difficult to discriminate by clinical history or neurological findings.
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PMID:[Hypoglycemic hemiplegia: a report of three cases]. 1180 22

Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases.
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PMID:Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases. 1239 82


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