Lecture 41: Hemiparesis and stroke

Question 1

Compare hemiparesis to paraparesis

Answer 1

Hemi: unilateral weakness in the face, arm, and leg. Can have range of causes

Para: bilateral weakness in the legs. Generally due to a T12 spinal cord segment gone

Question 2

Compare the presentation of weakness due to Pyramidal UMN lesion and someone with LMN weakness

Answer 2

UMN:
-in the upper limbs: flexor muscles less weak than extensor: Arm pressed to side

• lower limbs: extensor muscles less week than flexor: walks with a stiff leg and foot may scrape the floor
• also associated with increased tone (spastic catch), increased reflexes and extensor plantar response on same side of the lesion

LMN weakness pattern just depends on muscles supplied by the nerve root/peripheral nerve damaged.

• reduced tone, reflexes and flexion plantar response

Question 3

What is the main cause of UMN weakness and how does this affect presentation

Answer 3

Stroke causing an infarcted core which can expand to an ischemic penumbra.

As the leg homunculus is supplied by anterior cerebral artery whereas face and arms are by middle cerebral artery so there can be some difference in pattern of weakness - arms worse than legs

Question 4

How can stroke be treated

Answer 4

Needs to be treated at the earliest stage: 4-24hrs

Solitaire stent retriever is allows for clot retrieval within the cerebral arteries, feeding through the femoral.

Patient then left on aspirin, statins and anti-epileptic medications