HEMIPARESIS/HEMIPLEGIA

HEMIPARESIS/HEMIPLEGIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is it intermittent? Intermittent hemiparesis or hemiplegia would suggest migraine or transient ischemic attacks from basilar artery or carotid artery disease.
2. Is it sudden or gradual in onset? Sudden onset of hemiparesis would suggest a cerebral thrombosis, hemorrhage, or embolism. However, contusion or concussion of the spinal cord can occasionally produce a sudden onset of hemiparesis or hemiplegia. If there is a history of trauma, a subdural or epidural hematoma must be suspected. Gradual onset of hemiparesis or hemiplegia would suggest a space-occupying lesion.
3. Is there facial paralysis or other cranial nerve signs? If there is a central facial palsy or other cranial nerve signs, one would look for a lesion above the foramen magnum (i.e., in the brain). If there are no cranial nerve signs, a spinal cord lesion should be suspected.
4. Is there a fever? The presence of fever should suggest a cerebral abscess, venous sinus thrombosis, or encephalitis.
5. Is there a history of trauma? The history of trauma with hemiparesis or hemiplegia would suggest a subdural or epidural hematoma or a hemorrhage in the brain itself.
6. Is there a history of hypertension? The history of hypertension along with hemiparesis or hemiplegia suggests a cerebral hemorrhage. However, a cerebral thrombosis or cerebral aneurysm may also occur with a history of hypertension.
7. Is there auricular fibrillation or another embolic source? The presence of auricular fibrillation, cardiac murmur, or other signs of an embolic source would suggest a cerebral embolism.

DIAGNOSTIC WORKUP

A neurologist should be consulted at the outset because he can best determine what type of imaging study should be done. A spinal tap is no longer done without first doing an imaging study. Carotid scans can be done to rule out carotid artery insufficiency. Four-vessel cerebral angiography may be indicated, especially in transient ischemic attacks. Magnetic resonance angiography has become an acceptable noninvasive technique for evaluating the cerebral blood flow, especially in the vertebral-basilar arteries. EKG, echocardiography, and blood cultures will help identify an embolic source, but a cardiologist should be consulted to investigate this further. SSEP, BSEP, and VEP studies along with a spinal tap will help diagnose multiple sclerosis.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

More About Alternating Hemiplegia

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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