Onset Of Hemiplegia Research Articles

Abnormal brain and muscle energy metabolism shown by 31P-MRS in familial hemiplegic migraine

Familial hemiplegic migraine (FHM) is a rare autosomal dominant disorder of unknown pathogenesis characterized by migraine and transitory hemiplegic attacks. We describe a kindred fulfilling the diagnostic criteria for FHM in which: (1) brain phosphorus magnetic resonance spectroscopy ( 31P-MRS) showed a reduced phosphocreatine content accompanied by high [ADP], high percentage of V/Vmax of ATP biosynthesis and decreased phosphorylation potential; (2) muscle 31P-MRS showed a reduced rate of phosphocreatine recovery after exercise; (3) blood lactate was increased after effort; (4) muscle biopsy showed, in one patient, rare ragged red fibers succinate-dehydrogenase positive and cytochrome c oxidase negative; (5) genetic analysis of muscle mitochondrial DNA did not show any of the two point mutations in the tRNA Leu(UUR) associated with the MELAS syndrome (Mitochondrial myopathy, Encephalopathy with Lactic Acidosis and Stroke-like episodes). The defective energy metabolism of brain and muscle found in this pedigree suggests a multisystemic disorder of mitochondrial function in this FHM pedigree.

Alternating hemiplegia of childhood: a study of 10 patients and results of flunarizine treatment.

Alternating hemiplegia of childhood is a rare syndrome characterized by onset before 18 months of age of frequent attacks of alternating paralysis, transient ocular palsies, nystagmus, choreoathetosis, and autonomic dysfunction. We describe features of 10 patients followed for up to 27 years. The mechanism of alternating hemiplegia remains unknown but an association to migraine is suspected because of the strong family history of migraine and aura symptoms in some patients. We treated nine patients with flunarizine, a calcium channel blocker, for up to 5 years; they showed a reduction in duration of the hemiplegic attacks, but the episodes ceased completely in only one patient. With long-term follow-up, the persistent motor, movement, and cognitive deficits are more apparent. It is not certain if the flunarizine alters this course.

123I-iodoamphetamine SPECT brain imaging in alternating hemiplegia

Alternating hemiplegia of childhood is an unusual disorder characterized by early onset (occurring before 18 months of age); repeated attacks of hemiplegia involving both sides of the body; other paroxysmal phenomena, such as tonic stiffening, dystonic posturing, choreoathetoid movements, ocular motor abnormalities, and autonomic disturbances, in association with bouts of hemiplegia or occurring independently; and evidence of mental or neurologic deficits. A girl was examined because of left hemiplegia at the age of 16 months. The patient had begun exhibiting episodes of alternating hemiplegia at approximately 4 months of age. They consisted of tonic stiffening and dystonia of the right or left extremities, lasting from 30 min to several hours and followed by residual hemiparesis. They were invariably accompanied by ocular motor abnormalities. Magnetic resonance imaging, computed tomography, and angiography all were normal. Single proton emission computed tomography brain images during an acute episode of right hemiplegia demonstrated hypoperfusion of the left cerebral hemisphere. Following improvement of the hemiplegia, the patient was re-evaluated. The uptake of the radiotracer in the left hemisphere was increased. The scan did not demonstrate significant asymmetry in cerebral perfusion.

Shoulder pain in hemiplegia: statistical relationship with five variables.

The incidence of shoulder pain and the statistical relationship between it and five other variables (patient age, time since onset of hemiplegia, range of hemiplegic shoulder external rotation, spasticity and weakness) were investigated retrospectively. Of 50 consecutive hemiplegic patients whose records were reviewed, 36 had shoulder pain. The variables significantly (p less than 0.01) correlated with shoulder pain were: time since onset of hemiplegia (r = 0.45) and ROSER (r = -0.61). The relationship between shoulder pain and range of shoulder motion remained significant when other factors were partialled out. The relationship between shoulder pain and time since onset was not significant when the affect of range of shoulder motion was partialled out. Therefore, range of shoulder external rotation was considered the factor related most significantly to shoulder pain. This finding suggests that shoulder pain demonstrated by hemiplegia patients may be, in part, a manifestation of adhesive capsulitis.

Acute hemiplegia of infancy and childhood in Addis Ababa: report on 50 followed up cases.

From 1978 to 1982, 50 consecutive cases of acute infantile and childhood hemiplegias were followed up at our Neurology clinic. Fifteen cases (30%) were below the age of two years and 34 cases under five years of age (68%). Our youngest patient was six months and the oldest 13 1/2 years. The male to female ratio was 1.3:1. An acute onset of hemiplegia was noted in 64% of cases. A right side hemiplegia was more common than a left (1.5:1). Idiopathic cases, where no clinical associations could be made, bacterial meningitis, head traumas, and encephalitis were the four leading causes of acute hemiplegias in our series. (A complete recovery was noted in 82% of cases without associated clinical causes.) Subsequent development of epilepsy was noted in 10% of cases at follow-up.

Familial Hemiplegic Migraine—A Reappraisal and a Long-Term Follow-Up Study

Six patients (two females and four males in one family) with hemiplegic migraine are described. The age of onset was between six and eighteen years. Hemiplegic attacks were usually accompanied by transient neurological disturbances referable to the territory of the vertebrobasilar arterial tree. Brain-stem involvement and vertebrobasilar dysfunction in the reported family was supported by angiography in one case, revealing a marked and prolonged spasm of the basilar artery. Despite its dramatic character and occasionally prolonged deficits the course was essentially benign. Hemiplegic attacks disappeared during adolescence in five of the six patients. No permanent neurological residual phenomena were encountered during a mean follow-up of 14 years. The possibility is raised of a genetically determined susceptibility to periodic vasoconstriction in a particular vascular area as the basis of the syndrome.

Middle meningeal haemorrhage demonstrated angiographically.

Haemorrhage from the middle meningeal artery is a surgical emergency which does not usually call for examination by carotid arteriography. Head injury followed by deepening unconsciousness (with or without a lucid interval), the onset of hemiplegia, the falling pulse rate, and the eye signs are the well known features of a clinical picture which calls for immediate craniotomy. Occasionally, the case history is unusual and, with the increasing tendency to utilise carotid arteriography in patients suffering from head injuries, extra-dural haematomata are demonstrated by the resulting vascular displacement. The actual demonstration by angiography of the haemorrhage occurring from the middle meningeal artery must be a very rare occurrence. The author has only been able to find one example in the literature (Jamieson, 1952). The following case history and arteriographic studies of a patient suffering from haemorrhage from the posterior branch of the right middle meningeal artery is presented. The bleeding poin...

SPINAL ANESTHESIA IN HYPERTENSION

ABSTRACT To the Editor: —Dr. Albert S. Hyman (The Journal, October 28, p. 1410) presents preliminary statement on the therapeutic use of spinal anesthesia for emergency relief certain types of hypertension. He says that the depressor effect obtained by spinal anesthesia might be of value when sudden dropping of the systolic pressure is to be desired and cites case which seemingly an imminent cerebral hemorrhage was forestalled by such treatment. He concludes that in cases of extreme hypertension exhibiting prodromal signs of oncoming apoplexy and with relative grades of anemia, spinal anesthesia may be life saving.On the other hand, Dr. Stanley Cobb (The Cerebral Circulation: XXV. Remarks on Clinical Physiology, Ann. Int. Med.7:299 [Sept.] 1933) refers to an article which presents a strong case for the theory that lowering blood pressure patients with hypertension and arteriosclerosis may bring on attacks of hemiplegia

A RELATION OF CARDIOVASCULAR DISEASE TO HEMIPLEGIA

There is no condition that so quickly transfers a patient from the care of one specialist to another as the onset of hemiplegia in cardiovascular disease. Up to the time of the onset of this complication there is no question that the treatment of the person is a problem for the heart specialist. After the onset of hemiplegia, no one would question that he has passed into the domain of the neurologist. The role of the cardiologist up to this time is the prevention, or at least the postponement, of this complication that is always on the horizon. In the first five years of my practice after leaving the hospital I was closely associated with neurology in that department of the Vanderbilt Clinic. In this busy institution I saw many hundreds of examples of hemiplegia in all its stages, and from every different cause. Later, I spent a period in

Relation of Increased Blood Viscosity to Transient Attacks of Hemiplegia

Relation of Increased Blood Viscosity to Transient Attacks of Hemiplegia

Hereditary Epilepsy for Fifty Yearsʼ Duration Cured by an Attack of Hemiplegia

Hereditary Epilepsy for Fifty Yearsʼ Duration Cured by an Attack of Hemiplegia

A Further Note on the Return of the Knee Jerk in a Tabetic Patient after an Attack of Hemiplegia

A Further Note on the Return of the Knee Jerk in a Tabetic Patient after an Attack of Hemiplegia

Two Cases of Intra-cranial Syphilis

Case 1.—There was, in the following case, no history of syphilis, but the appearances post mortem seem to me to warrant the diagnosis. It may be asserted that the severe blow on the man's head was not merely, as I suppose, the determining cause of intra-cranial syphilis, but that it alone, without the predisposing help of syphilitic taint, led to the changes discovered post mortem. The nodules in the testis, however, were, I think, pretty conclusive evidence that all the blow did was to determine syphilis locally. The cicatrices in the liver were more than merely suggestive. Further, the disease of the cerebral arteries was quite like that seen in cases in which there is such evidence as nodes to demonstrate the existence of syphilis. The first attack of hemiplegia, if not the second, was due doubtless to local softening consequent on thrombosis of a syphilitic artery. Such an indirect mode of production of paralysis in syphilitic cases must always be carefully considered. It has been described in this country by Bristowe, Wilks, Moxon, Broadbent, Buzzard, and myself. I have recorded several cases.—“Lond. Hosp. Rep.,” Vol. 4, 1868.

Two Cases of Intra-cranial Syphilis

Case 1.—There was, in the following case, no history of syphilis, but the appearances post mortem seem to me to warrant the diagnosis. It may be asserted that the severe blow on the man's head was not merely, as I suppose, the determining cause of intra-cranial syphilis, but that it alone, without the predisposing help of syphilitic taint, led to the changes discovered post mortem. The nodules in the testis, however, were, I think, pretty conclusive evidence that all the blow did was to determine syphilis locally. The cicatrices in the liver were more than merely suggestive. Further, the disease of the cerebral arteries was quite like that seen in cases in which there is such evidence as nodes to demonstrate the existence of syphilis. The first attack of hemiplegia, if not the second, was due doubtless to local softening consequent on thrombosis of a syphilitic artery. Such an indirect mode of production of paralysis in syphilitic cases must always be carefully considered. It has been described in this country by Bristowe, Wilks, Moxon, Broadbent, Buzzard, and myself. I have recorded several cases.—“Lond. Hosp. Rep.,” Vol. 4, 1868.