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

In 18 monkeys ipsilateral flaccid hemiplegia of the hind-limb was produced by spinal cord hemisection at T8. As a result of systematic observations of various phenomena subsequent to the hemisection for several months, it was found that an ipsilateral marked exaggeration of the knee-jerk gradually developed in 2--3 weeks after the infliction, along with slight atrophy of the hind-limb muscles on the same side. The exaggeration reached a maximum in about 6 weeks and persisted thereafter for several months until the final experiments. The exaggeration of knee-jerk was confirmed by measuring quantitatively photographed trajectories of a small lamp attached to the malleolus, a specially devised hammer being used. The trajectories showed larger amplitudes, shorter rise times and lower thresholds on the hemisected side. Achilles tendon reflex was also observed to be hyperactive. However, there was no evidence of other pathological phenomena such as clonus or Babinski's sign in the present experiment. It was noted that total spinal cord transection one segment below the hemisected site did not abolish the exaggeration of knee-jerk. Another noticeable finding was that quadriceps afferent volleys picked up from the L6 dorsal root following tendon taps were smaller on the hemisected side, in spite of the fact that distinct augmented reflex potentials were observed in the ipsilateral L6 ventral root. These results strongly suggest that the exaggeration of knee-jerk was not induced by a release from tonic supraspinal inhibition nor by augmented quadriceps afferent volleys, but by some neural mechanisms which developed gradually within the lumbo-sacral segments below the hemisected site.
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PMID:Exaggeration of knee-jerk following spinal hemisection in monkeys. 81 87

The results of the present electrophysiological investigation have shed some light on the mechanisms underlying many clinical signs, at least, in patients with capsular hemiplegia. A tentative interpretation of them is given below. Cerebral lesions due to haemorrhage or infarction in the area of the middle cerebral artery interrupt an extensive part of the corticospinal tract and disturb many other descending pathways involved in voluntary performance. In consequence, a marked reduction in the ability to drive the spinal motor apparatus occurs, resulting in weakness of motor power. Here, we refer only to muscle power but not to performance. For example, the disturbance of voluntary contraction by clonus is disregarded (cf. fig. 8). On the other hand, the same lesions also release the spinal reflexes from inhibition by the higher levels of the brain and cause increased excitability in flexors and extensors. In the lower extremity, this is much more makred in extensors and extensor spasticity becomes a dominant sign clinically. Any release effect on the flexor system is largely cancelled by the high activity of the reciprocal Ia inhibitory pathway from extensors and only a fragment of it is occasionally revealed in some patients as an H-reflex in pre-tibial muscles or as weak Ia inhibition of the triceps surae. Reduced driving power of the brain may be compensated by raised excitability in the spinal cord and spastic extensors are thus naturally in a better condition to preserve motor power. Flexor muscles are doubly crippled by reduced descending impulses and strong reciprocal inhibition by the Ia impulses from the spindles of the extensor muscles.
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PMID:Reciprocal Ia inhibition in spastic hemiplegia of man. 100 Feb 87

The effects of dantrolene sodium (Dantrium) were studied in 23 patients with hemiplegic spasticity, 13 of whom were younger than 50, and 10 older than 50. The dosage of dantrolene ranged from 100 mg per day initially to 600 mg per day maximally. The drug was most effective in reducing or abolishing clonus and somewhat less efficacious in decreasing the resistance to stretch and the tendon reflexes. Functionally, gait was improved and the patients found it easier to take care of their personal needs. In general, motor performance was improved. The observation that patients in the 50+ age group responded less well remains unexplained. Dantrolene sodium is a valuable tool in the management of spasticity due to hemiplegia.
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PMID:Effect of dantrolene sodium on spasticity associated with hemiplegia. 114 24

The modification of a new design in orthosis usually has its clinical indication. In this study, a low-temperature thermoplastic ankle foot orthosis (AFO) was designed in anterior leaf type, called anterior AFO, to meet the need of indoor barefoot walking in Taiwan. It could be easily molded and remolded to fit the foot, as well as to adjust the position of the foot and ankle. Sixty-eight patients with acute hemiplegia were fitted with this anterior AFO during ambulation training: 46 had good fitting (67.6%), 15 had fair fitting (22.1%) and 7 had poor fitting (10.3%). Two patients were observed to have ankle clonus, and four patients experienced breakage or tear of the AFO within 4 wk. The gait characteristics were measured in six chronic hemiplegia patients to compare the effect of anterior AFO with posterior AFO (Teufel style). Their gait pattern did improve by AFO fitting, especially from the foot pressure distribution, but no significant difference between the two types of AFO was found.
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PMID:Clinical trial of a low-temperature plastic anterior ankle foot orthosis. 173 44

A double-blind study was carried out in 105 patients with chronic spasticity associated with hemiplegia in order to compare the efficacy and tolerability of tizanidine with that of diazepam. Dosage was increased progressively, if tolerated, to a maximum of 24 mg tizanidine or 30 mg diazepam per day at the end of 2 weeks. The optimum dosage was then maintained for 6 weeks. Efficacy and tolerability parameters were assessed after 2 and 8-weeks' therapy. Patients on tizanidine but not those on diazepam showed a statistically significant improvement in functional status, as assessed by walking distance on flat ground. Analysis of the stretch reflex in four groups of muscles showed that both tizanidine and diazepam reduced the duration of contractions and increased the angle at which contraction occurred, but there were no significant differences between the two drugs. Clonus of the triceps surae resolved in 48% of tizanidine and 40% of diazepam patients. Evaluation of the effect of therapy revealed an improvement with each drug in approximately 83% of patients, with the overall evaluation being slightly (but non-significantly) in favour of tizanidine. There were fewer discontinuations of treatment in the tizanidine group as a result of side-effects. It would appear, therefore, that tizanidine is an effective and well-tolerated drug in the treatment of cerebral spasticity.
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PMID:A multi-centre, double-blind trial of tizanidine, a new antispastic agent, in spasticity associated with hemiplegia. 328 29

To determine the frequency and the natural history of neurological manifestations of dengue infection in Thai children, 1,493 children diagnosed with dengue infection by serology and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand from 1987 to 1998 were reviewed from prospectively recorded medical charts. There were 80 children identified with neurological manifestations, an incidence of 5.4% of all dengue patients. Of these, there were 41 males and 39 females, with ages ranging from 3 months to 14 years. They were categorized into 20 cases of dengue fever, 26 cases of dengue hemorrhagic fever and 34 cases of dengue shock syndrome. All cases experienced the neurological manifestations during the febrile stage of the illness. The patients were classified into an encephalitic group (called "dengue encephalopathy") (42), a seizure group (35) and a miscellaneous group (3). Encephalitic patients presented with alteration of consciousness (83.3%), seizure (45.2%), mental confusion (23.8%), nuchal rigidity (21.4%), spasticity of limbs (9.5%), positive clonus (4.8%), hemiplegia (2.4%) and positive kernig (2.4%), and were older than those in the other groups. Patients in the seizure group presented with seizure (100%) and positive clonus (2.9%). Abnormal laboratory findings included hyponatremia, abnormal liver enzymes and CSF pleocytosis. Dengue IgM and dengue PCR were not demonstrated in 16 CSF specimens. An autopsy finding of a child in the encephalitic group showed histologic evidence of encephalitis, the only case of confirmed dengue encephalitis in this study. One patient with encephalitic symptoms suffered from long-term neurological sequelae. The overall mortality rate was 5%. In conclusion, neurological manifestations including seizure and encephalopathy in children with dengue are not uncommon whereas dengue encephalitis is a rare entity.
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PMID:Neurological manifestations in dengue patients. 1155 87

The functional consequences of spasticity can be corrected by local, pharmacological or surgical treatments once the spastic muscle has been identified. However, this diagnosis can be tricky when the muscle in question is rarely involved in spasticity or when its mechanical action is unusual or poorly characterized. Here, we present the case of a man presenting with left hemiplegia after an ischaemic stroke. His gait was perturbed by foot clonus in the sagittal plan, which persisted after selective neurotomy of the gastrocnemius and soleus but disappeared after neurotomy of the peroneus longus. Clonus triggered by pushing up under the whole of the forefoot in the direction of dorsiflexion may not be related to spasticity of the triceps surae. We recommend screening for foot clonus by first pushing up on the sole of the foot under all five metatarsals. In a second step, selectively pushing up under the first metatarsal joint enables the physician to evidence spasticity of the peroneus longus.
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PMID:An unusual cause of foot clonus: spasticity of fibularis longus muscle. 2368 81

Selective blocks of the tibial nerve with aqueous solution of 5% phenol, after localization of the nerve by electrical stimulation, were performed in 30 patients with acquired hemiplegia for treatment of severe spasticity of the foot plantar flexors and ankle clonus. Ankle clonus disappeared in all patients and resistance to passive stretch was reduced substantially immediately after the procedure; orthotic fitting and ambulation training then were possible. Longterm followup (averaging 12.9 months) showed the gait to be improved and spasticity decreased in all patients; there were no indications for further treatment of plantar flexor spasticity. Fixed equinus deformity was prevented in all cases. The only significant complication was the development of paresthesias in eight patients (26.6%) The simplicity of the procedure, the functional results observed immediately, its longlasting effect, and the lack of serious complications, warrant its more widespread use in the treatment and prevention of deformities in the spastic foot of the hemiplegic patient. However, there should be further study about prevention of paresthesias, which occurred in a significant percentage of patients in this study.
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PMID:Phenol block of the tibial nerve in the hemiplegic patient. 2482 50

After a minimum period of eleven weeks post cerebrovascular accident and resulting hemiplegia, one hundred adult patients were assessed for sensory-motor deficits affecting the function of the paralysed upper extremity. This paper presents only the assessment of muscle tone, the disturbances of tone and its inter-relationship with other clinical manifestations. Kendall rank order correlations were computed for this purpose. A highly significant relationship (P < .001) was observed between selective spasticity of proximal joints and distal joints and between wrist and finger clonus with selective spasticity of wrist, finger and shoulder muscles. The spasticity in wrist flexors related highly with the inability to perform functional tasks. Inability to perform muscle function was also related to limitation of joint motion.
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PMID:Disturbances of muscle tone in the paralysed upper extremity following hemiplegia. 2502 53

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.
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PMID:A vertebral artery dissection with basilar artery occlusion in a child. 2558 66


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