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

A 51-year-old woman with no significant family history exhibited progressive presenile dementia followed by right-sided spastic hemiplegia and died 27 months after the onset of her illness. Brain MRI demonstrated a widespread abnormality in the cerebral deep white matter and corpus callosum. Neuropathologically, extensive destruction of axons and myelin and abundant axonal spheroids were found in the deep white matter, preferentially of the frontoparietal areas. The corpus callosum was also severely damaged. The cerebral cortex and subcortical U fibers remained intact. The pathological features were different among the lesions, reflecting the sequential degenerative processes of the white matter. This case is, to our knowledge, the third sporadic case of neuroaxonal leukoencephalopathy with axonal spheroids.
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PMID:Neuroaxonal leukoencephalopathy with axonal spheroids. 1213 5

The dissection of the internal carotid artery is a rare complication of acceleration traumas of the upper spine. 30% of these dissections are caused by road accidents and again less than 30% of these occur bilateral as shown here. The symptoms are fronto-temporal and periorbital starting headaches spreading out to the occiput and Horner's syndrome. Complete hemiplegia as in our case is an impressive exception but the doctor in attendance should think of the carotid dissection. The exclusion of this complication is obligatory because treatment and outcome depend on it.The dynamic effects of bilateral carotid dissections may, as shown here, lead to relapsing cerebral infarctions with persisting neurologic deficits up to manifest hemiparesis. But restitution can be accomplished if early diagnosed by DSA and/or MRI. Therapy of choice is early prevention of persisting neurologic deficits using effective dosed heparin and depending on the residual lumen of the vessel oral anticoagulants or platelet antagonists for one year.
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PMID:[Bilateral carotid dissection. A not to underestimate cause of neurological loss after road accident]. 1237 97

Japanese encephalitis (JE) is an encephalomyelitis involving cortex, subcortex, brainstem and spinal cord. There is paucity of studies on the neurophysiological evaluation in JE. This study aims at comprehensive evaluation of EEG, sensory and motor evoked potentials, nerve conduction and electromyography; and correlate these with clinical findings. Sixty five patients with JE diagnosed on the basis of clinical, radiological and virological criteria were subjected to a detailed clinical evaluation during the acute stage of illness. Cranial CT scan or MRI was carried out in all the patients. All the patients underwent 10 or 18 channel EEG, motor and sensory evoked potentials to both upper and lower limbs bilaterally as well as peroneal and sural nerve conductions and concentric needle EMG. Outcome, was defined at the end of 3 months into poor, partial and complete recovery. The patient's age ranged between 2-65 years. There were 40 males and 25 female patients. Fifteen patients were less than 12 years of age. History of seizure was present in 31 patients. Quadriplegia was seen in 39 and hemiplegia in 8 patients. Muscle wasting was present in 16 patients and tendon reflexes were reduced in 12 and of mixed pattern in 14 patients. Cranial MRI revealed thalamic lesion in 38, basal ganglia in 21, substantia nigra in 30, pons in 5, cerebellum in 3 and cerebral cortex in 7 patients out of 57 patients. EEG revealed nonspecific theta to delta slowing in 45, alpha pattern coma in 5 and epileptiform discharges in 8 patients. EMG revealed fibrillations in 23 patients. Motor evoked potentials were abnormal in 34 out of 46 patients and revealed patchy and focal abnormalities comprising of unrecordable, prolonged and normal pattern. Somatosensory evoked potentials were abnormal in 8 patients only. At 3 month, 26 patients had complete, 13 partial and 15 had poor outcome. Eight patients died in acute stage and 3 were lost to followup. MEP correlated with weakness and 3 month outcome whereas EEG, SEP and EMG did not have any correlation. MEP changes were more frequent in JE and had prognostic significance.
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PMID:Neurophysiological changes in Japanese encephalitis. 1239 49

MRI, done later in life, in two patients with infantile hemiplegia syndrome showed significant volume loss in the cerebellar hemisphere contralateral to the side of the affected cerebrum. The cerebellar volume loss seemed to correlate with the degree of volume loss in the contralateral cerebral hemisphere. These observations provide morphological evidence of the phenomenon of crossed cerebral-cerebellar diaschisis (CCD). Functional neuroimaging studies in support of the concept of CCD has been critically reviewed.
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PMID:Crossed cerebral - cerebellar diaschisis: MRI evaluation. 1239 62

Many central nervous system conditions that cause weakness, including many strokes, injure corticospinal tract but leave motor cortex intact. Little is known about the functional properties of surviving cortical regions in this setting, in part because many studies have used probes reliant on the corticospinal tract. We hypothesized that many features of motor cortex function would be preserved when assessed independent of the stroke-affected corticospinal tract. Functional MRI was used to study 11 patients with chronic hemiplegia after unilateral stroke that spared regions of motor cortex. Activation in stroke-affected hemisphere was evaluated using 3 probes independent of affected corticospinal tract: passive finger movement, a hand-related visuomotor stimulus, and tapping by the nonstroke index finger. The site and magnitude of cortical activation were similar when comparing the stroke hemisphere to findings in 19 control subjects. Patients activated each of 8 cortical regions with similar frequency as compared to controls, generally with a smaller activation volume. In some cases, clinical measures correlated with the size or the site of stroke hemisphere activation. The results suggest that, despite stroke producing contralateral hemiplegia, surviving regions of motor cortex actively participate in the same proprioceptive, visuomotor, and bilateral movement control processes seen in control subjects.
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PMID:Motor cortex activation is preserved in patients with chronic hemiplegic stroke. 1240 58

Cerebral venous sinus thrombosis is a rare, serious cerebrovascular disease with poor prognosis. It can be a sequel to various coagulation disturbances, head injuries or local inflammations. We report a case of a young woman with no risk factors detected, who developed a massive cerebral venous sinus thrombosis. She had progressively worsening symptoms, including left hemiplegia, aphasia, tonic-clonic seizures and unconsciousness. The diagnosis was supported by CT, MRI and angio-MRI findings. The intensive i.v. heparin and streptokinase treatment, as well as antibiotics, resulted in full remission of all patient's symptoms. The case emphasizes the necessity of early diagnosis and management of cerebral venous sinus thrombosis.
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PMID:[Cerebral venous thrombosis: a young woman case study]. 1252 23

One of the most devastating consequences of early corticospinal lesions is the impaired dexterity that results in a noticeable deficit while manipulating small objects. One purpose of the present study was to investigate the extent to which a deficit in the coordination of fingertip forces when grasping and lifting an object between the thumb and index finger could account for the impaired dexterity in patients with congenital hemiplegia (CH). A second objective was to examine whether, in these patients, deficits in skilled hand movements are correlated with the importance of structural damage to the corticospinal tract. The scaling and coordination of fingertip forces during precision grip was investigated in 16 CH patients (aged 8-19 years) and 16 age- and sex-matched control subjects. Proprioception, stereognosis, pressure sensitivity and motor upper limb function (including digital and manual dexterity) were also assessed quantitatively. The structural damage of the corticospinal tract was estimated by measuring the cross-sectional area of cerebral peduncles with MRI and by calculating an index of symmetry between the two peduncles. In CH patients, a large number of parameters measured during the grip-lift task were significantly different when compared with those found in control subjects. Among those, the duration of the preloading and loading phases was significantly longer in CH patients. In addition, both the dissimilarity and time-shift between the profiles of the grip and load force rates, quantified with the cross-correlation method, were also significantly larger in CH patients; the time-shift was strongly correlated with impaired dexterity. These findings suggest that impaired dextrous finger movements in CH patients may specifically result from their inability to ensure a precise synergy between fingertip forces while manipulating an object. Finally, the finding that the time-shift also correlated with the corticospinal tract dysgenesis, as estimated with the cerebral peduncle asymmetry, argues in favour of a critical role of the corticospinal system in the temporal coordination between different muscles involved in dextrous hand movements. Both digital and manual dexterity were also altered in the non-paretic hand of CH patients. This deficit may reveal the contribution of the lesioned hemisphere to the control of ipsilateral skilled finger movements.
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PMID:Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia. 1256 93

We report the case of a 67 year old patient admitted at our institution for acute onset of left hemiplegia. MRI was done 2 h 30 after symptom onset. Diffusion weighted images showed a hyperintense lesion in the right basal ganglia region with restricted apparent diffusion coefficient (ADC=428. 10(-6) mm(2)/s), a 50% decrease in value compared to the normal left side, consistent with acute ischemia. The lesion was hyperintense and moderately heterogeneous at FLAIR imaging, best seen on echo planar T2W images, with hypointense rim consistent with magnetic susceptibility artifact. The appearance and location of the lesion suggested the possibility of hematoma, which was confirmed at CT. Interpretation of ADC values must be performed in correlation with results at imaging including sequences sensitive to magnetic susceptibility artifacts such as echo planar T2*W and T2W sequences in order to exclude the possibility of underlying hematoma.
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PMID:[Intracerebral hematoma associated with reduced apparent diffusion coefficient mimicking acute stroke]. 1262 92

Behcet's disease is a multisystem vasculitis. Its neurologic complications include different syndromes. The purpose of this investigation was to study the prevalence of neurologic manifestations among patients with Behcet's disease and to determine the frequency of different symptoms, signs, and syndromes in neuro-Behcet's disease. Ninety-six consecutive patients who were referred to the Behcet's Disease Clinic in Shiraz (southern Iran) were interviewed and thoroughly examined. Psychiatric evaluation, CSF analysis, electroencephalography, electrodiagnostic studies, and neuroradiologic imaging (preferably MRI) were performed in appropriate cases. Six patients (6.3%) had definite neuro-Behcet's disease. They were 4 males and 2 females (mean age 37.5 years). In 2 patients Behcet's disease had not been diagnosed before. The most frequent symptoms of neuro-Behcet's disease were headache (83.3%), paresthesia (83.3%), unsteadiness (66.7%), diplopia (66.7%), and weakness (50%). The most frequent signs were gait abnormalities (66.7%), sensory abnormalities (66.7%), ophthalmoplegia (50%), cerebellar ataxia (50%), and hemiplegia (50%). The most common syndrome was brain-stem+ type (50%). Subacute onset and relapsing-remitting course were the most common temporal patterns. Neurological manifestation is a relatively less frequent complication of Behcet's disease but it produces severe disabilities. It must be considered in differential diagnosis of multiple sclerosis.
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PMID:Neuro-Behcet's disease: a masquerader of multiple sclerosis. A prospective study of neurologic manifestations of Behcet's disease in 96 Iranian patients. 1264 28

A-38-year-old man suddenly developed nausea, vomiting and vertigo during chiropractic neck manipulation. This was followed by right hemiplegia, right deep sensory disturbance and left hypoglossal nerve palsy, consistent with the medial medullary infarction (Dejerine syndrome). The MRI revealed infarction at left medial part of the medulla. The vertebral angiogram and MRA showed marked narrowing of the left vertebral artery. X-rays of the cervical spine showed no spondylosis, dislocation nor osteolysis of the odontoid process. The serological studies, including lupus anticoagulant, protein C, and protein S gave normal results. Although vascular accidents involving the brain stem after chiropractic neck manipulation have been reported since Pratt-Thomas and Berger, previous reports are still rare. In them lateral medullary infarction (Wallenberg syndrome) is probably the most common case. On the other hand, medial medullary syndrome (Dejerine syndrome) is absolutely rare. To our knowledge, the only one report has been made by Watanabe and his colleagues before our present case. The mechanism was suggested that rotation and tilting of the neck stretches and compresses the vertebral artery at the cervical joint causing injury to the vessel, with an intimal tearing, dissection, and pseudoaneurysm formation. Consequently, the present case may be caused by injury to the left vertebral artery with an intimal tearing during neck manipulation sufficient to cause disection and subsequent infarction of the brain stem.
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PMID:[The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation]. 1268 91


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