Lecture 38: Clinical 5: Hemiparesis & stroke

Question 1

Define Hemiparesis

Answer 1

• Hemiparesis/plegia: unilateral weakness(paresis)/paralysis(plegia) of face, arm and leg

Question 2

Define Paraparesis

Answer 2

• Paraparesis/paraplegia: bilateral weakness/paralysis of both legs

Question 3

What is Pyramidal upper limb weakness

Answer 3

Pyramidal Weakness (Paresis) • Upper limbs: the flexor muscles may be weak but are stronger than the extensors. • Lower limbs: the extensor muscles may be weak but are stronger than the flexors. People with “pyramidal” (UMN) lesions have a characteristic posture and gait • Upper limb held flexed

Question 4

What is Pyramidal lower limb weakness

Answer 4

Pyramidal Weakness (Paresis) • Lower limbs: the extensor muscles may be weak but are stronger than the flexors. People with “pyramidal” (UMN) lesions have a characteristic posture and gait • Lower limb extended so that the person walks with a stiff leg and the foot may scrape the floor

Question 5

What is Pyramidal (UMN) weakness also associated with?

Answer 5

Pyramidal (UMN) weakness is also associated with: • Increased tone (spastic catch) of hemiplegic side – clasp-knife rigidity • Increased reflexes of hemiplegic side • Extensor plantar response of hemiplegic side

Question 6

What is the pattern of damage in lower motor neurone weakness?

Answer 6

Lower Motor Neurone Weakness Pattern depends on which nerve root or peripheral nerve is damaged (e.g. C5 nerve root lesion → shoulder abduction weakness) • Decreased tone • Decreased reflexes • Flexor plantar response (normal)

Question 7

What would you see in a CT scan in an acute subdural haematoma

What symptoms would you observe?

Answer 7

• Accumulation of blood in the subdural space
• Some swelling
• Effaced ventricles
• Midline shift (under falx cerebri)
• Hemiparesis on the left side with in_creased tone_, increased reflexes, and extensor plantar response
• Normal motor function on the right side

Question 8

What is this?

What would you observe?

Answer 8

Frontal meningioma (left)

Present with depression due to frontal lobe lesion

No hemiparesis or sensory findings

• A slow progress that compressing anterior cerebral artery (leg area), so brain has time to adjust to the situation.
• Note that we will have motor and sensory symptoms if it is a acute setting such as stroke.

When surgically removed, patient retrieved to normal

Question 9

Patient:

What are the signs that she presents with?

Answer 9

Focal neurological signs:

• Non-fluent/expressive/Broca’s aphasia with mild dysarthria (e.g. especially bad with speaking names, gets around by describing things)
• Problems in writing
• Right hemiparesis
• Right sensory disturbance

No receptive component since understanding (e.g. Wernicke’s area) is normal.

No visual/hearing problems.

Question 10

What is the Solitaire Stent Retriever?

Answer 10

Within 6 hours

Guiding catheter (squirt dye to track), then feed wire, open stent (wire spread out), mesh the clot and take out.

• Femoral artery à carotid artery à middle cerebral artery

Risk of reperfusion injury, hemorrhage (due to fragile damaged brain tissue) when drugs given (within 4.5 hours) or stent (within 6 hours)