TAILIEUCHUNG - Chapter 023. Weakness and Paralysis (Part 4)

Hemiparesis Hemiparesis results from an upper motor neuron lesion above the midcervical spinal cord; most such lesions are above the foramen magnum. The presence of other neurologic deficits helps to localize the lesion. Thus, language disorders, cortical sensory disturbances, cognitive abnormalities, disorders of visual-spatial integration, apraxia, or seizures point to a cortical lesion. Homonymous visual field defects reflect either a cortical or a subcortical hemispheric lesion. A "pure motor" hemiparesis of the face, arm, or leg is often due to a small, discrete lesion in the posterior limb of the internal capsule, cerebral peduncle, or upper pons. Some brainstem lesions. | Chapter 023. Weakness and Paralysis Part 4 Hemiparesis Hemiparesis results from an upper motor neuron lesion above the midcervical spinal cord most such lesions are above the foramen magnum. The presence of other neurologic deficits helps to localize the lesion. Thus language disorders cortical sensory disturbances cognitive abnormalities disorders of visual-spatial integration apraxia or seizures point to a cortical lesion. Homonymous visual field defects reflect either a cortical or a subcortical hemispheric lesion. A pure motor hemiparesis of the face arm or leg is often due to a small discrete lesion in the posterior limb of the internal capsule cerebral peduncle or upper pons. Some brainstem lesions produce crossed paralyses consisting of ipsilateral cranial nerve signs and contralateral hemiparesis Chap. 364 . The absence of cranial nerve signs or facial weakness suggests that a hemiparesis is due to a lesion in the high cervical spinal cord especially if associated with ipsilateral loss of proprioception and contralateral loss of pain and temperature sense the Brown-Sequard syndrome . Acute or episodic hemiparesis usually results from ischemic or hemorrhagic stroke but may also relate to hemorrhage occurring into brain tumors or as a result of trauma other causes include a focal structural lesion or inflammatory process as in multiple sclerosis abscess or sarcoidosis. Evaluation begins immediately with a CT scan of the brain Fig. 23-3 and laboratory studies. If the CT is normal and an ischemic stroke is unlikely MRI of the brain or cervical spine is performed. Figure 23-3 An algorithm for the initial workup of a patient with weakness. EMG electromyography LMN lower motor neuron NCS nerve conduction studies UMN upper motor neuronSubacute hemiparesis that evolves over days or weeks has an extensive differential diagnosis. A common cause is subdural hematoma especially in elderly or anticoagulated patients even when there is no history of trauma. Infectious .

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