Clinical syndromes
Albert Michael in Get Through MRCPsych Parts 1 and 2: 1001 EMIQs, 2004
His girlfriend drags a 36-year-old man to the A&E department. They are poor historians and they change their stories often. Match each scenario with one diagnosis: 1. The girlfriend says that he got drunk and fell off the staircase. He had worsening headache, vomiting and fits. On examination, he has disorientation, brisk reflexes, upgoing plantar, hemiparesis and bleeding from his ears.
Motor Dysfunction and Recovery
Julian Bogousslavsky in Long-Term Effects of Stroke, 2002
The challenging aspect in each stroke patient is the question to what degree he or she will recover from his or her neurological deficit. Studies on large clinical cohorts showed that approximately half of the patients with completed stroke have persistent hemiparesis (1). Most recovery occurs during the first weeks following stroke (2, 3). Stroke can interfere with virtually every single capacity of the human brain. The resulting deficits can either be assessed in global terms such as the disability level of daily activities or scored for specific neurological impairments (4). The adequate assessment of the functional state has become increasingly important, as the correlation with the tissue perfusion state and with the recruitment of perilesional areas during functional activation provides the ground for evaluation of the efficacy of new therapeutic interventions that have recently come into clinical use. Since most of the recovery takes place early after stroke, a major question regarding the underlying mechanisms is how far the restoration of tissue function contributes to the reorganization of the remaining network.
Physical, sensory, perceptual and mood deficits
Graham Lowings, Beth Wicks in Effective Learning after Acquired Brain Injury, 2016
Issues relating to gross (whole body) motor skills and co-ordination will be fairly obvious to identify when observing the person’s ability to run, walk, jump etc. However, equally important is an assessment, for instance, of whether the person can sit comfortably for the duration of the educational input. Fine motor skills are much smaller movements usually relating to use of the hands, for example, when writing. It should also be noted that it is not uncommon for those with ABI to suffer some specific form of physical difficulty, for example, hemiplegia or hemiparesis (paralysis or weakness on one side of the body), ataxia (tremor) and dyspraxia (difficulties planning and co-ordinating movement).
A case of hypoglycemic hemiparesis and literature review
Published in Upsala Journal of Medical Sciences, 2012
Tetsuhiro Yoshino, Shu Meguro, Yukie Soeda, Arata Itoh, Toshihide Kawai, Hiroshi Itoh
An 89-year-old man with diabetes treated with metformin 500 mg/day and glimepiride 4 mg/day was hospitalized because of hypoglycemic right hemiparesis and dysarthria (casual glucose value 1.8 mmol/L), which resolved quickly following administration of 40 mL of 40% dextrose. Hemiparesis is a rare symptom (4.2%) of hypoglycemia. There are about 200 case reports of hypoglycemic hemiparesis. The average glucose level at which hemiparesis developed was 1.8 mmol/L. Right-sided hemiparesis predominated (R 66%; L 34%). On imaging studies, abnormal findings were frequently observed in the internal capsule or splenium of the corpus callosum. The mechanism of hemiparesis is not fully understood. The existence of cases in which hypoglycemia cannot be distinguished from stroke on imaging studies suggests the importance of measurement of the blood glucose level when the symptoms of stroke are first recognized.
Costs and Rehabilitation Use of Stroke Survivors: A Retrospective Study of Medicare Beneficiaries
Published in Topics in Stroke Rehabilitation, 2009
Richard D. Zorowitz, Er Chen, Kuo Bianchini Tong, Marianne Laouri
Objective: To examine mortality, costs, and rehabilitation use in patients with stroke and stroke-related hemiparesis during a 4-year period following stroke onset. Method: This study was a retrospective, longitudinal claims analysis. Patients newly diagnosed with stroke and discharged from the hospital were identified from a 5% random sample of Medicare beneficiaries. Mortality, total Medicare costs, use of rehabilitation, and associated costs in stroke survivors with or without hemiparesis were the main outcome measures. Results: Out of 4,604 newly diagnosed stroke patients, 1,166 developed hemiparesis. The 4-year mortality rate was significantly higher in the hemiparesis cohort than the nonhemiparesis cohort (55.2% vs. 47.5%; p < .01). The average Medicare cost per patient over the 4-year period was $77,143 for the hemiparesis cohort and $53,319 for the nonhemiparesis cohort (p < .01). A significantly higher proportion of patients in the hemiparesis cohort received rehabilitation than in the nonhemiparesis cohort (84% vs. 36% in Year 1, 30% vs. 10% in Year 2, 21% vs. 9% in Year 3, 16% vs. 7% in Year 4). Among patients who received rehabilitation, costs were significantly higher for the hemiparesis cohort ($17,680) than for the nonhemiparesis cohort ($7,841) in the first year. While most rehabilitation costs for the hemiparesis cohort were incurred in the hospital inpatient setting in the first year, the cost burden shifted to skilled nursing facilities and home health agencies in the following 3 years. Conclusions: Hemiparesis following stroke onset contributes to a higher mortality rate and higher Medicare costs in both the short and long term.
The evaluation of non-use of the upper limb in chronic hemiparesis is influenced by the level of motor impairment and difficulty of the activities–proposal of a new version of the Motor Activity Log
Published in Physiotherapy Theory and Practice, 2019
Erika Shirley Moreira Silva, Natalia Duarte Pereira, Anna Carolyna Lepesteur Gianlorenço, Paula Rezende Camargo
ABSTRACT This study aims to evaluate the influence of the degree of difficulty of the activities in Motor Activity Log (MAL) scores for patients with mild, moderate, and severe hemiparesis, and to estimate the correlation between motor impairment levels of hemiparesis and MAL scores in post-stroke patients. Sixty-six patients with chronic hemiparesis (49 with mild–moderate hemiparesis, and 17 with severe hemiparesis) were evaluated by the Fugl–Meyer upper-limb section and versions of MAL for different degrees of motor impairment. The Rasch model was used to analyze the level of difficulty of the activities of the different versions of MAL. The Spearman’s correlation tested the relationship between the Fugl–Meyer Assessment upper-limb section and MAL. The MAL version, developed to evaluate patients with severe hemiparesis, does not contain the easier activities as employed by the Rasch analysis. There was positive correlation between the Fugl–Meyer Assessment upper-limb section scores and Amount of Use of the three versions of the MAL (r = 0.76, 0.78, and 0.77). The difficulty of the activities seems to influence the quantity and quality of use of the affected upper limb in individuals with chronic hemiparesis. A new version of MAL is proposed for individuals with severe motor impairment.
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