Lecture 38: Clinical 5: Hemiparesis & stroke Flashcards Preview

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Flashcards in Lecture 38: Clinical 5: Hemiparesis & stroke Deck (10)
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1
Q

Define Hemiparesis

A

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

2
Q

Define Paraparesis

A

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

3
Q

What is Pyramidal upper limb weakness

A

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

4
Q

What is Pyramidal lower limb weakness

A

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

5
Q

What is Pyramidal (UMN) weakness also associated with?

A

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

6
Q

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

A

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)

7
Q

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

What symptoms would you observe?

A
  • 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
8
Q

What is this?

What would you observe?

A

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

9
Q

Patient:

What are the signs that she presents with?

A

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.

10
Q

What is the Solitaire Stent Retriever?

A

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)