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

Stroke patients are often left with hemiplegia or hemiparesis of the upper extremities, severely limiting the ability to perform bimanual and functional activities. No studies have investigated how stroke patients adapt their movements to changes in object size in functionally asymmetric bimanual tasks. The influence of object size on intralimb and interlimb coordination during an asymmetrical, functional bimanual task was examined in patients with left cerebral vascular accidents (LCVA) and healthy controls. Fourteen LCVA patients and 13 age-matched controls were instructed to reach to grasp a large and a small jar with the right/affected hand and to open the cap with the other hand. Movement kinematics was analyzed for intralimb coordination (spatial and temporal planning of reaching and grasping) and interlimb coordination (bimanual synchronization and temporal association of the hands). The results demonstrate a spatial adaptation of reaching in the affected hand to the object size and deficits in temporal planning of grasping with the affected hand to object size in the stroke patients. Movement adaptations of the unaffected hand in the stroke patients were similar to those in the healthy adults. Bimanual coordination was independent of object size for both groups.
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PMID:Effects of object size on intralimb and interlimb coordination during a bimanual prehension task in patients with left cerebral vascular accidents. 1895 40

We report a case of a perinatally HIV-infected patient aged 9 years, who presented with right-sided hemiplegia. His initial CD4 T-cell was of 0.21% (4 cells/muL) and plasma HIV RNA virus of 185 976 copies/mL (log 5.27). Plasma and CSF samples were subsequently positive for JCV. Twelve days after the initiation of highly active antiretroviral therapy (HAART), the MRI showed progressive white matter lesions with asymmetrical deep and subcortical white matter lesions over the left frontotemporoparietal region and the right frontal lobe. Immune Reconstitution Inflammatory Syndrome (IRIS) was suspected, and the patient was treated with methylprednisolone. His clinical symptoms worsened and despite therapy the patient deteriorated.
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PMID:Progressive Multifocal Leukoencephalopathy in HIV-Infected Children: A Case Report and Literature Review. 2004 Oct 4

We report acute encephalopathy in two cases with severe congenital hydrocephalus. Case 1 was a 23-month-old girl, born at of 36weeks gestation and delivered by cesarean section due to congenital hydrocephalus. Magnetic resonance imaging (MRI) showed prominent ventricular dilation associated with hydrocephalus, Dandy-Walker variant and cortical malformation. The blood test for toxoplasmosis, syphilis, varicella-zoster, rubella, cytomegalovirus, and herpes simplex virus (TORCH) complex and various metabolic tests of blood and urine specimens yielded unremarkable results. She was admitted to our hospital for respiratory failure with fever and her clinical course deteriorated, progressing to hemiconvulsion hemiplegia epilepsy syndrome. Case 2 was a 17-month-old boy, born by spontaneous vertex delivery at 39weeks. Severe, asymmetrical ventricular dilation associated with hydrocephalus, cerebellar and brainstem hypoplasia, and punctuate calcifications of the thalamus, third and fourth ventricles, around the aqueduct, were observed on computed tomography (CT). The blood test for TORCH complex and various metabolic tests of blood and urine specimens yielded unremarkable results. He was admitted to our hospital for status epilepticus with fever and his clinical course progressed to hemorrhagic shock and encephalopathy syndrome. In patients with brain disorders, diagnosis and treatment are likely to be delayed and prognosis may thereby be worsened. When status epileptics or prolonged coma manifests even in patients with severe brain disorders, we must consider encephalopathy in the differential diagnosis.
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PMID:Acute encephalopathy in two cases with severe congenital hydrocephalus. 2109 88

Scoliosis is an important cause of disability in childhood, due to its incidence and limitation on ability. In neurodevelopmental disabilities, scoliosis worsens the already limited functional capacities of the child and can thwart abilities partially recovered through rehabilitation. In celebral palsied children (CP), scoliosis is considered a consequence of damage to the central nervous system or a complication of a peripheral impairment, in particular, through obliquity of pelvis, of the unilateral dislocation of hip. In order to explain the scoliosis of central origin, primitive and pathological reflexes, reactions or automatisms must be taken into account, especially the asymmetrical ones. This contradicts the absence of scoliosis in hemiplegia. On the contrary, symmetrical patterns should act as protective factors. However, the greater incidence of scoliosis in tetraplegia than in dipegia does not confirm this idea. Scoliosis is secondary when it is linked to an unilateral hip dislocation for side of convexity, proximity, measure and timing sequence. In childhood neuromuscular diseases (NMD), scoliosis is the unavoidable consequence of muscle weakness. The only protective factor may be muscle stiffness in case of fibrotic degeneration. The main curve is reducible for longer periods, while the less reducible secondary one at cervical level can limit the correction possibilities, due to the need to keep the head aliened. In spina bifida (SB) children, lesional and supralesional scoliosis can be present. In the former, the malformative ones directly derive from the vertebrae involved in the myelomeningocele and the secondary ones develop from the unilateral hip dislocation similar to CP, or from muscular imbalance (a typical feature of SB, especially for lower lumbar levels) or from primitive skeletal malformations of pelvic girdle or lower limbs. The acquired ones are caused by muscle weakness as in NMD. In the supralesional scoliosis, the curve is the consequence of an impairment in neurological structures especially of ponto-cerebellar carrefour or of an acquired tethered cord and may affect any segment of spinal column, also above the primitive lesion level. The scoliosis in neurodevelopmental disabilities can be treated conservatively with corsets and postural systems, with limited results. or through a surgical approach, often made difficult due to the multiple impairments present in the same patient.
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PMID:Severe scoliosis in neurodevelopmental disabilities: clinical signs and therapeutic proposals. 2122 89

This study was conducted to investigate the effects of asymmetrical body posture alone, i.e., the effects seen in children with mild scoliosis, vs. the effects of body posture control impairment, i.e., those seen in children with unilateral cerebral palsy on gait patterns. Three-dimensional instrumented gait analysis (3DGA) was conducted in 45 children with hemiplegia and 51 children with mild scoliosis. All the children were able to walk without assistance devices. A set of 35 selected spatiotemporal gait and kinematics parameters were evaluated when subjects walked on a treadmill. A cluster analysis revealed 3 different gait patterns: a scoliotic gait pattern and 2 different hemiplegic gait patterns. The results showed that the discrepancy in gait patterns was not simply a lower limb kinematic deviation in the sagittal plane, as expected. Additional altered kinematics, such as pelvic misorientation in the coronal plane in both the stance and swing phases and inadequate stance phase hip ad/abduction, which resulted from postural pattern features, were distinguished between the 3 gait patterns. Our study provides evidence for a strong correlation between postural and gait patterns in children with unilateral cerebral palsy. Information on differences in gait patterns may be used to improve the guidelines for early therapy for children with hemiplegia before abnormal gait patterns are fully established. The gait pathology characteristic of scoliotic children is a potential new direction for treating scoliosis that complements the standard posture and walking control therapy exercises with the use of biofeedback.
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PMID:Gait pattern differences between children with mild scoliosis and children with unilateral cerebral palsy. 2508 8

A question still debated within cognitive neuroscience is whether signals present during actions significantly contribute to the emergence of human's body ownership. In the present study, we aimed at answer this question by means of a neuropsychological approach. We administered the classical rubber hand illusion paradigm to a group of healthy participants and to a group of neurological patients affected by a complete left upper limb hemiplegia, but without any propriceptive/tactile deficits. The illusion strength was measured both subjectively (i.e., by a self-report questionnaire) and behaviorally (i.e., the location of one's own hand is shifted towards the rubber hand). We aimed at examining whether, and to which extent, an enduring absence of movements related signals affects body ownership. Our results showed that patients displayed, respect to healthy participants, stronger illusory effects when the left (affected) hand was stimulated and no effects when the right (unaffected) hand was stimulated. In other words, hemiplegics had a weaker/more flexible sense of body ownership for the affected hand, but an enhanced/more rigid one for the healthy hand. Possible interpretations of such asymmetrical distribution of body ownership, as well as limits of our results, are discussed. Broadly speaking, our findings suggest that the alteration of the normal flow of signals present during movements impacts on human's body ownership. This in turn, means that movements have a role per se in developing and maintaining a coherent body ownership.
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PMID:Are movements necessary for the sense of body ownership? Evidence from the rubber hand illusion in pure hemiplegic patients. 2577 41

Painless aortic dissections in general are uncommon and are frequently misdiagnosed. Here we reported a rare case of acute ischemic stroke secondary to completely painless acute full-length dissection (DeBakey I) and provide a brief review of the literature. A 56-year-old man was referred to our department with right hemiplegia. Ischaemic stroke and thrombolytic treatment were considered initially. At the second examination, the patient was found to have decreased blood pressure, asymmetrical blood pressure/pulses between the bilateral limbs, and sudden loss of pulse in a lower extremity. Laboratory results revealed leucocytosis, elevated creatinine and CK without obvious cause. An aortic dissection was subsequently confirmed by contrast enhanced thoracic and abdominal CT scan. Our report provides some clues for the early diagnosis of painless aortic dissections.
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PMID:Unexpected cause of a right hemiplegia secondary to the painless full-length aortic dissection: a case report and literature review. 2593 76

The present report is of two patients who, immediately after internal carotid endarterectomy, presented with unexplained hemiplegia, despite normal findings on repeated MRI scans, which secondarily evolved into homolateral subacute corticobasal syndrome (CBS), with asymmetrical hemispheric hypometabolism and evidence of dopaminergic denervation. This prompted us to propose an hypothesis of transient cerebral hypoxia arising during the surgical clamping period that might have provoked a prolonged or permanent functional lesion of the left hemisphere and basal ganglia, with no visible infarction on MRI but only synaptic rearrangement of the neural networks, thereby revealing or exacerbating a potentially preexisting silent impairment.
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PMID:Subacute corticobasal syndrome following internal carotid endarterectomy. 2915 71

Pelvic retraction during walking is a common finding seen in patients with spastic hemiplegia. However, potential factors related to this condition have not been comprehensively examined in a systemic manner in previous studies. The purpose of this study was to elucidate any clinical and gait parameters related to pelvic retraction in patients with hemiplegic cerebral palsy. A total of 212 independent ambulatory patients were enrolled in the study. Group I consisted of 113 patients who had persistent pelvic retraction, and Group II of 99 with a normal range of pelvic rotation throughout the gait cycle as evidenced by kinematic analysis. A multivariate logistic regression analysis using a clustering technique was performed, with use of eight gait factors and five clinical factors. Decreased ankle dorsiflexion, increased hip internal rotation, increased anterior pelvic tilt, the Winters classification type II, and asymmetrical posturing of the upper extremity during gait were found to be related to pelvic retraction. This is the only study including a broader array of assessment domains of both clinical and gait parameters with a considerably large and homogenous population with hemiplegia. Further studies will be needed to see whether the rectification of those parameters may improve abnormal gait and pelvic retraction in hemiplegia.
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PMID:Clinical and Gait Parameters Related to Pelvic Retraction in Patients with Spastic Hemiplegia. 3109 87

Supplementary motor area, the posterior third of the medial aspect of superior frontal gyrus, is known to be a heterogeneous area in function. It is involved in self-initiated motor movements, planning and sequencing the motor action, response inhibition, and bimanual movements. Blood supply for supplementary motor area is mostly by callosomarginal branch of anterior cerebral artery. Stroke in anterior cerebral artery territory is relatively uncommon, moreover, isolated supplementary motor area stroke is a rare entity. Supplementary motor area stroke, as a syndrome, has variable symptoms consisting of impairment of volitional movements, hemineglect, dyspraxia of contralateral limbs, impaired muscle tone, mutism and contralateral weakness. As symptoms are sometimes ambivalent, patients may be misdiagnosed as functional disorder and lose the chance for immediate adequate treatments such as thrombolysis. We report a 59-year-old man with previous history for myocardial infarction, referred to emergency room with an acute dense right-side hemiplegia, positive Hoover sign, asymmetrical Babinski responses and intermittent ability to move his arm in some specific reflex actions despite plegia. Since brain computed tomography scan was unremarkable we could not be sure whether his symptoms were organic or functional until a diffusion weighted imaging of magnetic resonance imaging elucidated the situation. To our knowledge, there is only one case report in the literature prior to ours, presenting a supplementary motor area stroke patient, mimicking functional disorder. Therefore, we may claim our report to be the second reported case.
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PMID:Stroke in supplementary motor area mimicking functional disorder: a case report. 3139 88


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