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Herpes simplex encephalitis (HSE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. A 7-year-old Malay girl with known case of right hemiplegia secondary to herpes encephalitis presented to the neuropediatric ward, in General Hospital with refractory seizure. She had a moderate learning disability and diagnosed as right hemiparesis secondary to herpes encephalitis complicated with epilepsy. She was planned for the positron emission tomography (PET) scan and to undergo operation if PET scan was feasible (Hemispherectomy). However, the patient refused for operation. Prompt clinical recognition is important in the HSE to prevent progressive brain tissue damage, haemorrhagic changes, and worsening of the encephalitis. Diagnosis is usually confirmed through an extensive evaluation, including a thorough clinical examination with attention to findings on mental status changes, cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG) testing and findings on neuroimaging. Once HSE is suspected, high-dose acyclovir should be started immediately before lumbar puncture (LP), and only stopped once a definitive alternate diagnosis has been established. This case is reported because the patient has generalized epilepsy with right hemiparesis secondary to herpes encephalitis. Herpes encephalitis with right hemiparesis cases are quite rare.

Stroke following manual strangulation is a rare presentation. We report a case of 61-year-old man with no known comorbidities presenting with right hemiplegia following manual strangulation. Neuroimaging showed left middle cerebral artery territory infarct along with left posterior watershed infarct. Although isolated cases of thromboembolic stroke and watershed infarcts have been reported, combined watershed infarct and thromboembolic stroke in a person has not been reported till date to the best of our knowledge. The probable mechanism is discussed based on literature review. The need for anticipation of delayed cerebrovascular injuries and appropriate investigations in all strangulation victims who arrive at emergency department is also stressed upon based on this case report.

Purpose: This study examined the effects of action observational training to improve the gait function for patients with stroke. Methods: The participants were divided into two groups: right hemiplegia group (n=12) and left hemiplegia group (n=12). All groups received conventional therapy for five sessions for 30 minutes, each for three weeks. Left and right hemiplegia group practiced additional action observational training for five sessions for 20 minutes each for three weeks. They participated in three weeks of action observa tional training coupled with immediate physical practice (intervention), followed by a final assessment. The duration of each action ob servation video sequence was 10 minutes, followed immediately by practice of the observed motor skill (10 minutes). The gait velocity, cadence, swing time, step length, and BOS (base of support) were examined using the GAITRite system. Results: The results of this study showed significant improvement in the gait function. The outcomes of the gait abilities from gait veloc ity, cadence, swing time, step length of the affected side, and BOS (base of support) were improved significantly in the right hemiplegia group (p

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.

espanolEl accidente cerebrovascular en adultos jovenes es un evento raro presente en menos del 5% de los casos a nivel mundial, representandoun reto diagnostico debido a las multiples etiologias posibles, entre ellas las infecciones. Del 15% al 40% de los pacientes con sifilis no tratada pueden desarrollar sifilis terciaria con manifestaciones principalmente eurodestructivas, descritas en la sifilis tardia pero con meningitis cronica y accidente cerebrovascular de tipo meningovascular en su fase temprana. Se presenta el caso de un paciente masculino de 40 anos con antecedente de cambios de comportamiento, alucinaciones auditivas e insomnio, quien consulta a urgencias por presentar hemiplejia derecha, afasia motora, lesiones palmo-plantares y roseta en glande asociada a adenopatias inguinales. Dados los hallazgos imagenologicos y de liquido cefalorraquideo se establecio diagnostico de accidente cerebrovascular isquemico de circulacion cerebral anterior izquierda secundario a neurosifilis meningovascular, con confirmacion de inmunosupresion por virus de inmunodeficienciahumana. MED.UIS.2019;32(2):53-8 EnglishStroke in young adults is a rare event present in less than 5% of cases worldwide, representing a diagnostic challenge due to the multiple possible etiologies, including infections. 15% to 40% of patients with untreated syphilis may develop tertiary syphilis; with mainly neurodestructive manifestations, described in late syphilis, but in its early stage with chronic meningitis and meningovascular stroke. The case of a 40-year-old male patient with a history of behavior changes, auditory hallucinations and insomnia is presented, who consults the emergency department for presenting right hemiplegia, motor aphasia, palmoplantar lesions and rosette in glans associated with inguinal adenopathies. Given the imaging and cerebrospinal fluid findings, a diagnosis of ischemic stroke of the left anterior cerebral circulation was established, secondary to meningovascular neurosyphilis, with confirmation of immunosuppression due to human immunodeficiency virus. MED.UIS.2019;32(2):53-8

Acute carbon monoxide (CO) poisoning remains a common cause of poison-related death and influences neurological function. An 83-year-old female was transferred to our emergency unit due to hypertension with dizziness, headache, and right hemiplegia. There was no radiographic evidence of ischemic stroke. The family members reported that the patient may have been exposed to CO by briquettes burned inside a closed room. High flow oxygen therapy was given for suspected CO intoxication and her symptoms quickly improved. Although we do not have clear evidence, we presume that hemiplegia in our patient was caused by CO intoxication, based on rapid recovery with oxygen therapy, carboxyhemoglobin (COHb) level elevation (3.0%), polycythemia, and neuroimaging. Despite the hematogenous effects of CO, paralysis appeared to be more severe on her right side than on her left side. MRI and blood tests helped to support CO as the suspected cause of her hemiplegia. This case reconfirms the importance of medical interviewing by medical practitioners, even in an emergency setting.

Thymic epithelial tumors (TET) are rare lesions. The brain metastases of these tumors are even rarer. We report a case of brain metastases in a known patient with a thymic carcinoma diagnosed in October 2016. She was a 73-year-old woman who presented with headache, nausea, and right hemiplegia. Brain MRI revealed five lesions (1 insular, 1 frontal and 2 left temporal, 1 right parafalcine). These lesions were initially treated using two stereotactic radiosurgery gamma knives. A macroscopically complete excision of the left frontal lesion was subsequently performed without any complications with a good evolution of the neurological symptoms postoperatively. Immunohistochemical examination was compatible with metastatic thymic carcinoma. The patient died 14 months after the initial diagnosis. A review of the literature in English has reported another 45 TET cases with brain metastases.

Primary angiitis of the central nervous system is an uncommon disease that may affect adults and the pediatric population. It can involve both the medium-large and small sized cerebral blood vessels, and can be associated with inflammatory, infectious, tumor processes, or of idiopathic origin. The case is presented of an adolescent with focal neurological impairment due to right hemiplegia, in whom other more frequent causes of cerebral ischemia were ruled out. The final diagnosis was Epstein Barr virus associated with primary angiitis of the central nervous system.

Objective: The left and right sides of the brain has different roles. This study investigated the differences in cognitive driving ability between stroke survivors with damage to the left brain and right brain. Therefore, the purpose of this study was to compare the driving cognitive ability of left and right hemispheric drivers following stroke. Design: Cross-sectional study. Methods: The Stroke Drivers’ Screening Assessment (SDSA) from the UK was translated to the Korean Stroke Drivers’ Screening Assessment (K-SDSA) to meet the specific traffic environments of Korea. The SDSA is composed of 4 tasks :1) a dot cancellation task that measures concentration and visuospatial abilities necessary for driving, 2) a directional matrix task to measure spatio-temporal executive function required for driving, 3) a compass matrix task to measure accurate direction determination ability required for driving, and 4) recognition of traffic signs and reasoning ability to understanding traffic situation. The SDSA assessment time is about 30 minutes. The K-SDSA was used to compare the cognitive driving abilities between 15 stroke survivors with left and 15 stroke survivors with right brain damage. Results: There were significant differences between the persons with stroke patients with left brain lesions (right hemiplegia) compared to the persons with stroke with right brain lesions (left hemiplegia) (p

This case report presents the clinical record of a 37-year-old man who presented with a dense right hemiplegia, found to be caused by a left medial medullary stroke. The cause of the stroke was unclear, and bacterial endocarditis was initially suspected. However, he was ultimately found to have neurosyphilis on a background of undiagnosed human immunodeficiency virus and was treated with benzylpenicillin. This case report reviews the diagnosis of neurosyphilis and highlights the importance of considering neurosyphilis as a rare but important cause of stroke, especially given the increasing prevalence of syphilis in Australia.

Aims: Compare haptic exploratory procedures (EPs) and exploratory movements (EMs) of children. This study also tested the interrater reliability of a novel digital recording method. Methods: Participants were 31 children with typical development (TD) (aged 6 years 1 month to 15 years 9 months; 14 male) and 23 children with spastic unilateral cerebral palsy (CP) (aged 6 years to 15 years 5 months; 13 males; right hemiplegia, n = 12). Results: There were no statistically significant differences between groups for expected EP (p = .15), additional EPs (p = .78), or EMs (p = .69) but there was for mean duration of exploration (p < .001) and accuracy (p < .001). This suggests that although children with CP performed similar haptic EPs for each object as children with TD, they took more time and were less accurate in their identification. There was substantial agreement between the two raters' observations of expected EP, κ = .64, p < .0005. Conclusion: Children with CP performed similar haptic EPs as their TD peers. However, despite similarities, the results indicate that for children with CP manual ability was not the primary determinant of accuracy or speed of identification. This study provides evidence for a reliable method of recording haptic EPs.

[Purpose] The purpose of this study was to examine the effects of task-specific plantar flexor training on walking ability indices in a patient with a paretic ankle. [Subject and Methods] The subject was a 65-year-old male patient with right hemiplegia due to a left medullary ventral infarction. An ABA' single-subject design was adopted. The independent variable was a task-specific plantar flexor training exercise, similar to that during walking, targeting the paretic ankle. The dependent variables were the isometric ankle plantar flexor strength, maximum walking speed, step length, and trailing limb angle in the paretic terminal stance phase. The B study phase was divided into B1 and B2 phases. A two standard-deviation-band method was used to evaluate improvement. [Results] Improvements in the paretic plantar flexor strength, maximum walking speed, step length, and trailing limb angle in the B2 phase were observed. The improvements in the maximum walking speed, step length, and trailing limb angle were sustained in the A' study phase. [Conclusion] These results suggest that task-specific plantar flexor training exercise is efficacious in improving the walking ability index of a paretic ankle.

The purpose of the present study was to examine the effectiveness of the NDT method (Bobath) in children with CP. Twenty children with cerebral palsy (7 with quadriplegia, 6 with diplegia and 7 with right hemiplegia), with mean age of 4. 85 ± 2. 49 years, took part in the study. Materials-Method: The children participated in an intervention that consisted of an 8-week Bobath program. GMFM-88, PEDI and TUG scores were measured across three time points during the intervention (a baseline measurement, a second at the end of the intervention and a post-intervention measurement one month after the end of the intervention). Results: The results of the NDT intervention showed that the participant children significantly improved their GMFM-88 and TUG scores between initial and final measurement and maintained this one month later (F2,36 = 69,778, p < 0.001), while in PEDI the intervention program had no statistically significant effect (F2,36 = 0.844, p = 0.438). In conclusion, there is strong evidence of the effectiveness of the NDT (Bobath) method in improving the mobility of children regardless of the frequency of its application.

Background Cases of SARS-COV-2 triggering or exacerbating autoimmune responses has been described in the literature, and it has shown that use of steroids in non-severe COVID-19 may potentially increase mortality. Case presentation A 22 year-old African-American man presented with headache, weight, loss, and oral/scrotal ulcerations. Case report Neurological exam revealed somnolence and right hemiplegia. MRI was remarkable multiple enhancing lesions involving the brainstem and left hemisphere. He was found to have a positive SARS-CoV-2 test. Work-up was unrevealing, and he was diagnosed with Neuro-Behcet's disease (NBD) based on the International Criteria for Behcet's Disease (ICBD)ackspaceD)BackspaceBackspacep. The patient was treated with systemic steroids, which resulted in both clinical and radiological improvement of his disease without exacerbation of his SAR-CoV-2 infection. Conclusions This case presentation suggests that IV steroids may be safe in the treatment of NBD in adult patients presenting with SARS-CoV-2 infection.

This study described the effects of a proprioceptive neuromuscular facilitation (PNF) program on balance, strength, and mobility in an older adult with chronic stroke. The patient was male, aged 69 years, with right hemiplegia for 17 years, and had diminished balance, balance confidence, lower extremity (LE) strength, and gait velocity. He received 1 h of PNF-based therapy thrice a week for six weeks. Outcome measures were: Mini-BESTest, limits of stability (LOS), Activities-Specific Balance Confidence Scale (ABC), Five Time Sit-to-Stand Test (FTSST), Upright Motor Control Test (UMCT), and 10 Meter Walk Test (10 MWT). The patient improved on the Mini-BESTest (25/28, from 21/28), FTSST (27.47 s, from 30.27 s), UMCT knee extension (moderate, from weak), and 10 MWT (0.82 m/s, from 0.67 m/s); and positive changes in LOS dimensions. PNF was effective in enhancing balance, strength, and mobility in an older adult with chronic stroke and may mitigate falls risk in this population. More research is needed to determine its impact in a larger sample of older people with chronic stroke.

Eagle syndrome is a rare condition, often characterized by nonspecific symptoms. It is due to an abnormally long or compressive styloid process on surrounding structures. Exceptionally, it can cause neuro-vascular manifestations. We report an observation of Eagle syndrome discovered incidentally in presence of recurrent transient ischemic stroke. A 74-year-old man with no cardiovascular risk factors, was admitted to our department following 4 episodes of transient ischemic stroke with right hemiplegia and aphasia, always rapidly resolving. Head and neck CT scan showed 2 long styloid processes with a marked impingement of the left one against the ipsilateral internal carotid artery. Intraoral styloidectomy was performed. The patient recovered fully and remained free of symptoms without neurological impairment, at 6 months. Eagle syndrome is a rare condition which may lead, exceptionally, to repetitive transient ischemic stroke. Surgical styloidectomy must be considered to reduce the risk of new vascular events and prevent serious complications such as dissection of the internal carotid artery.

Background Motor imagery (MI) training may benefit children with congenital hemiplegia, but reports on MI ability are mixed. This study considered individual patterns of performance to better understand MI ability in children with hemiplegia. Method Twenty children with hemiplegia (7–13 years; 10 with right hemiplegia), completed a MI task, IQ estimate and functional tests. Children with hemiplegia scoring above chance on the MI task were compared to a group of age-matched peers. The performance patterns of those scoring below chance were considered individually. Results Three children with right hemiplegia were excluded due to low IQ. Seven of 10 children with left hemiplegia and three of seven with right hemiplegia performed MI at an equivalent level to peers without hemiplegia. The seven children with hemiplegia who scored significantly below chance scored lower on functional tests, but differences here failed to reach an adjusted significance level. Four of the seven appeared engaged in MI, but performed very poorly. The remaining three had unique performance patterns explored in more detail. Conclusion Motor imagery deficits are not universally observed in children with congenital hemiplegia and individual performance should be examined before completing group analyses. Recommendations for exclusions and reporting in future studies are made.

Rationale: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a condition characterized by biphasic convulsions and disturbance of consciousness. In Japan, the most common pediatric cases of acute encephalopathy are associated with infection. AESD usually occurs in early childhood, with the characteristic magnetic resonance imaging (MRI) appearance called “bright tree appearance.” The disease often has neurological sequelae and interferes with the schooling of children and their activities of daily living; however, there are few clinical case reports of hemiplegia caused by AESD. Patient concerns: A case with right-sided hemiplegia due to AESD in an 11-month-old girl who was followed up to 30 mo of age. Diagnoses: The patient was diagnosed with overlap AESD and hemiconvulsion-hemiplegia-epilepsy syndrome (HHE syndrome), based on the clinical course and imaging findings. DNA tests of her blood and cerebrospinal fluid revealed the presence of human herpesvirus 6. Interventions: Pharmacotherapy and rehabilitation therapy. Outcome: Gross motor function has recovered considerably, but she had a mild developmental delay at 30 mo old. Lessons: Hemiplegia due to AESD was extremely rare, and appropriate rehabilitation treatment resulted in recovery of physical function. However, as mild developmental delay was observed, the patient was referred to a specialized facility before entering school.

A 71-year-old male presented with right hemiplegia and global aphasia of 4 h duration. On admission the NIHSS was 25. On multimodal imaging, he was noted to have terminal ICA occlusion with small infarct core size. Direct mechanical thrombectomy was planned as IV tpa was contraindicated in view of recent myocardial infarction (Figs. 81.1, 81.2, 81.3, and 81.4).

A 61-year-old man presented with right hemiplegia and aphasia. NIH stroke scale was 20. The ASPECTS score was 9, and CT angiogram showed occlusion at the origin of the left internal carotid artery and left M1–MCA occlusion. He was started on IV tPA and transferred for endovascular management.

Contains fulltext : 199181.pdf (Publisher’s version ) (Open Access) Background: Previous studies suggest that compromised bimanual performance experienced by children with unilateral cerebral palsy (CP) is not only due to difficulties in action execution but may also be a result of impaired anticipatory action planning. Aims The effect of age and side of hemiplegia were examined and the relationship between anticipatory action planning, unimanual capacity and bimanual performance was explored. Methods and procedures: Using a multi-centre, prospective, cross-sectional observational design, anticipatory action planning was analyzed in 104 children with unilateral cerebral palsy, aged 6-12 years, using the sword task. Outcomes and results: Anticipatory action planning did not improve with age in children with unilateral CP, aged between 6-12 years. No differences were found between children with left or right hemiplegia. Finally, anticipatory action planning was not related to unimanual capacity or bimanual performance. Conclusion and implications: This study demonstrates anticipatory action planning, measured using the sword task, does not improve with age in children with unilateral CP and is not related to bimanual performance or laterality. Future studies of anticipatory action planning in children with unilateral CP should consider using measures that require effective anticipatory action planning for successful task completion rather than end state comfort. 9 p.

We present an interesting EEG finding of persistent unilateral sweat artifacts in a 47 years old male patient with right hemiplegia secondary to left thalamic bleed with extension of hemorrhage into the left internal capsule, the left midbrain and ventricles. The EEG was done for altered sensorium. It showed unilateral (right sided) sweat artifacts throughout the EEG recording. The anhydrosis on left side of the face was due to left sided Horner's syndrome because of involvement of first order neurons in the left midbrain. This EEG finding is highlighted because of it being relatively less common but interesting finding.

[Purpose] The purpose of this study was to investigate the effects of hand strength on upper extremity function and activities of daily living in patients with right hemiplegia, as well as to provide important fundamental data for rehabilitation after stroke. [Subjects and Methods] This study was conducted from May 1 to December 30, 2013, at the Department of Rehabilitation of P Hospital in Seoul and included subjects hospitalized with a diagnosis of stroke. Patients with right hemiplegia were selected, and their hand strength, upper extremity function, and activities of daily living were evaluated. Hand strength was measured by grip, lateral pinch, and three-point pinch strength. [Results] The effects of hand strength on upper extremity function were evaluated. The results showed that all types of hand strength significantly influenced upper extremity function. However, only grip strength influenced activities of daily living. [Conclusion] In rehabilitation of stroke patients, it is necessary to first improve their general physical condition and basic activities of daily living, and then improve hand movement and hand muscle strength for instrumental activities of daily living training, which requires detailed hand movements.

Georges Moreau (1848-1901) was a painter and the son of the famous psychiatrist Jacques-Joseph Moreau de Tours. Early in his career, his paintings aspired toward figurative perfection, exalting patriotic and historical themes. His prolific production includes numerous paintings for which he drew inspiration from psychology and certain mental pathologies. At the age of 45 years he suffered right hemiplegia which forced him to set aside large-scale subjects and focus instead on intimist, almost pointillistic works, which brought him closer to the Impressionists, as his portrait of Paul Cezanne shows. Possibly his most well-known painting, Les fascines de la Charite, service du Dr. Luys, is analysed here by comparison with La Lecon clinique a La Salpetriere by Andre Brouillet, which depicts Jean-Martin Charcot and his students.

BACKGROUND In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20-75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48±3.2 (mean±SD). CONCLUSIONS GEAR is potentially useful for gait exercise in hemiplegic patients.

Aim This study aimed to quantify the contribution of physical, personal and environmental characteristics to physical activity among independently ambulant children with unilateral cerebral palsy (CP). Method One-hundred and two children with unilateral CP (52 males, 50 females; 52 right hemiplegia; mean age 11y 3mo, range 8–17y [SD 2y 4mo]) classified at Gross Motor Function Classification System (GMFCS) levels I = 44 and II = 58 participated. Physical activity was measured over 4 days using ActiGraph accelerometers recording as activity counts. GMFCS, functional strength, 6-minute walk test (6MWT), mobility limitations (MobQues28), age, sex, Assessment of Life-Habits recreation domain, Participation and Environment Measure for Children and Youth (PEM-CY) and environmental characteristics were considered for selection in a linear regression model. These served as independent variables which were determined using a backwards selection procedure. Results Younger age, male sex, increased performance on the 6MWT, and increased participation in the home and community measured using the PEM-CY were significantly associated with activity counts (p

Unilateral skin reactions are rare in patients with neurologic impairments caused by vascular or metastatic disease. The pathophysiology of these unilateral reactions has not been characterized, although recent research in neurophysiology provides a few clues.

Objective: The objective of this study was to investigate the feasibility and effects of balance training using a newly developed elastic band orthosis (aider) for improvement of mobility and balance in chronic stroke patients. Design: Cross-sectional study. Methods: Ten patients with chronic hemiplegia participated in this study. There were six males and four females; two patients had right hemiplegia and eight had left hemiplegia. This study investigated the effect of the elastic band orthosis on balance and gait ability compared with bare foot condition. Gait parameters were measured using the opto-gait system for analysis of the spatial and temporal parameters of walking in stroke patients. In addition, balance ability in stroke patients was evaluated using the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Results: This study investigated the effect of the elastic band orthosis on balance compared with bare foot condition. The TUG and BBS showed significant improvement with use of the elastic band orthosis (p

PURPOSE: This study was conducted in chronic hemiplegic patients to examine the effect of the training of the ipsilateral arm that is identical to the model performing movements and the training of the contralateral arm on the function of the arm. METHODS: The subjects were participated total 2 patients(the subject 1 with left hemiplegia and the subject 2 with right hemiplegia). The study was conducted for 4 weeks. The action observation training were repeated 10 times in 10 days during intervention period. The evaluation of the arm function such as BBT, MFT and MAL in the each subject were examined 5 times in the baseline period, 10 times during the intervention period and 5 times during the baseline regression period. RESULTS: The results of the evaluation in each subject were presented as mean values and video graphs. The arm function of the 2 subjects were improved during the intervention period in comparison with the baseline period, and the improvement was maintained even during the regression baseline period. In addition, there were large variation ratio of BBT and MAL (AOU, QOM) in comparison with subject 1. CONCLUSION: According to the results, the action observation training was more effective in improving upper limb function of stroke patients who imitate the performed behavior of paralyed parts on the same side.

Itoh N, Kagaya H, Horio K, Hori K, Itoh N, Ota K, Kanada Y, Saitoh E. Relationship between movement asymmetry and sit-to-stand/stand-to-sit duration in patients with hemiplegia. Jpn J Compr Rehabil Sci 2012; 3: 66-71. Objective: To elucidate the relationship between sideto-side asymmetry and sit-to-stand and stand-to-sit duration in patients with right or left hemiplegia by three-dimensional motion analysis of the two movements. Methods: Forty-fi ve patients with hemiplegia (right hemiplegia in 21, left hemiplegia in 24) and 20 normal healthy adults were studied. Using three-dimensional motion analysis, an asymmetry index (AI) was calculated from the trajectory of the left-right component at the midpoint between two acromion markers as a function of time. Normal range of the sitto-stand and stand-to-sit duration was calculated as the mean ± SD obtained from normal subjects. Patients were divided into two groups according to duration: normal duration (within the mean ± 2SD of normal subjects) and abnormal duration (outside the mean ± 2SD of normal subjects). Motor function of the affected lower extremity and other parameters were compared between the normal and abnormal duration groups. Results: Sit-to-stand and stand-to-sit duration was signifi cantly prolonged in both right hemiplegic and left hemiplegic patients compared with normal subjects. In left hemiplegic patients, AI was signifi cantly higher in those with abnormal duration for both sit-to-stand and stand-to-sit movements. In left hemiplegic patients, the lower extremity motor function was signifi cantly poorer in those with abnormal duration for sit-to-stand movement. Conclusion: In patients with left hemiplegia, AI deviates toward the unaffected side, and impaired lower extremity motor function is associated with prolonged sit-to-stand duration.

[Purpose] The purpose of this study was to investigate the effects of mirror therapy on the upper extremity functions of stroke patients. [Subjects] The subjects of this study were 14 hemiplegia patients (8 males, 6 females; 9 infarction, 5 hemorrhage; 8 right hemiplegia, 6 left hemiplegia) who voluntarily consented to participate in the study. [Methods] The Korean version of the manual function test (MFT) was used in this study. The test was performed in the following order: arm movement (4 items), grasp and pinch (2 items), and manipulation (2 items). The experiment was conducted with the subjects sitting in a chair. The mirror was vertically placed in the sagittal plane on the desk. The paretic hand was placed behind the mirror, and the non-paretic hand was placed in front of the mirror so that it was reflected in the mirror. In this position, the subjects completed activities repetitively according to the mirror therapy program over the course of four weeks. [Results] There were significant increases in the grasp-and-pinch score and manipulation score. [Conclusion] In conclusion, the grasp-and-pinch and manipulation functions were improved through mirror therapy.

Buchwald (1878 ) used the term 'mirror writing' to indicate writing in the reverse direction to what is normal in a particular language and in which the individual letters are also reversed. Cases of healthy individuals (i.e., Leonardo da Vinci and Lewis Carroll) as well as brain-damaged patients have been described in the literature. Here, we report the case of PM, a 70-year-old right-handed woman who showed right hemiplegia and mirror writing following a stroke in the left lenticular nucleus and internal capsulae. PM underwent a complete neuropsychological evaluation, which included copying, dictation and spontaneous writing in both hemispaces with both hands. She was also tested for topographical disorientation, visuo-spatial disorders and body schema deficits. We observed isolated mirror writing only when PM wrote with the left hand, without differences between hemispaces. She also showed a left-right disorientation, a body topological map disorder and an egocentric misrepresentation. The presence of mirror writing not confined to one hemispace and the co-presence of executive function disorders, as well as anosognosia, suggests damage to our patient's sub-cortical frontal network. As no previous interpretation fits with PM's symptoms, we hypothesize that mirror writing resulted from damage to her egocentric frame of reference. This hypothesis allows us to interpret the patient's array of disorders, including mirror writing, body topological map disorder, left-right confusion and egocentric representation.

Mycotic aneurysms are rare, and depending on their location, can threaten functional prognosis. We report on a 17-year-old girl with no previous history of cardiovascular or infectious disease, referred to our Department of Cardiology with right hemiplegia and aphasia. A neurological evaluation revealed thrombosis of a mycotic cerebral aneurysm, complicated by ischemic and hemorrhagic infarction. Transthoracic echocardiography indicated huge, highly mobile mitral vegetation associated with a mitral regurgitation with a triple stream. Hemocultures isolated Staphylococcus lugdunensis. Shortly afterward, she developed bilateral tibial and pedal mycotic aneurysm. The patient received antibiotics, with minor neurological improvement initially, but she soon died because of a brain herniation. Based on our findings in this case, we discuss the features of endocarditis attributable to S. lugdunensis.

A 29-year-old man and a 36-year-old man developed attacks of acute neuro-Behcet’s disease (NB) (right Horner’s syndrome and right hemiplegia and dysarthria, respectively) during the course of chronic progressive NB (acute on chronic). Although both patients recovered from acute NB after treatment with infliximab or corticosteroids, they continued to show manifestations of chronic progressive NB. It is suggested that acute NB and chronic progressive NB are different in their pathogenesis.

Aim To evaluate spasticity under controlled velocities and torques in children with cerebral palsy (CP) using a manual spasticity evaluator. Method The study involved 10 children with spastic CP (six males, four females; mean age 10y 1mo, SD 2y 9mo, range 7–16y; one with quadriplegia, six with right hemiplegia, three with left hemiplegia; Gross Motor Function Classification System levels I [n=2], II [n=3], III [n=2], IV [n=2], and V [n=1]; Manual Ability Classification System levels II [n=5], III [n=4], and V [n=1]) and 10 typically developing participants (four males, six females; mean age 10y 3mo, SD 2y 7mo, range 7–15y). Spasticity and catch angle were evaluated using joint position, resistance torque, and torque rate at velocities of 90°, 180°, and 270° per second, controlled using real-time audio-visual feedback. Biomechanically, elbow range of motion (ROM), stiffness, and energy loss were determined during slow movement (30°/s) and under controlled terminal torque. Results Compared with typically developing children, children with CP showed higher reflex-mediated torque (p

[Purpose] This study was performed to investigate the balance of the stance limb of hemiplegic stroke patients during the crossing of obstacles of different heights. [Subjects] Twenty stroke patients (right hemiplegia) crossed obstacles of different heights (0 cm, 10 cm, 20 cm). [Methods] Stance time and muscle activity of the stance limb were measured during obstacle crossing. Two-way ANOVA was used to compare the stance time and muscle activities of the stance limb at the various obstacle heights. [Results] The results show that the stance time of the unaffected lower limb was significantly longer than that of the paretic lower limb and obstacle height increased, the stance time of the unaffected lower limb increased significantly. The participants exhibited increase in electromyography of the unaffected limb with increasing obstacle height. Particularly, the rectus femoris and gastrocnemius of the unaffected limb showed significant increases, and the tibialis anterior of the unaffected limb showed a significant difference between heights of 10 cm and 20 cm. Finally, the tibialis anterior and gastrocnemius showed significant difference between paretic and unaffected limb at all obstacle hights. [Conclusion] The results suggest that training the gastrocnemius of the paretic limb is an effective therapy for hemiplegic stroke patients.

[Purpose] The purpose of this study was to investigate the plantar foot pressure distribution of stroke patients while crossing obstacles of different heights. [Subjects] Eight subjects (right hemiplegia) participated in this study. [Methods] Plantar foot pressure was recoded by a RS-scan system (RS scan Ltd., German). One-way ANOVA was used to compare foot data of the various heights. [Results] The peak plantar pressure values of the paretic lower limb during the stance phase showed significant differences among the T1, M1, M2, M3 and M4 regions. However, the peak plantar pressure values of the non-paretic lower limb showed significant differences only in the T1, MF, HM and HL regions. [Conclusion] This study found that when stroke patients attempted to cross an obstacle, crossing the obstacle with the non-paretic lower limb while supporting the body with the paretic lower limb was a more stable and efficient obstacle crossing strategy.

●Abstract● Purpose: We report two cases of acute ischemic stroke patients treated by additional thrombectomy using a basket-shaped microsnare (Soutenir) after infusion of intravenous recombinant tissue plasminogen activator (rtPA). Successful recanalization and good prognosis were achieved in both cases. Case 1: A 67-year-old man presented with left hemiplegia and agnosia. After completion of the intravenous rtPA infusion, he continued to show severe neurological deficit. Angiography revealed occlusion of the posterior trunk and a branch of the anterior trunk of the right middle cerebral artery (MCA). The two occluded arteries were successfully recanalized by removing the clot with Soutenir, resulting in neurological improvement. Case 2: A 49-year-old man presented with right hemiplegia and aphasia. After completion of the intravenous rtPA infusion, he continued to show severe neurological deficit. Angiography revealed occlusion of the left MCA at the proximal M1 segment. The occluded artery was successfully recanalized by removing the clot in the manner described above, resulting in neurological improvement. Conclusion: To our knowledge, this is the first report describing patients treated by additional thrombectomy using a Soutenir after failed intravenous infusion of rtPA. This procedure is a therapeutic option for selected acute ischemic stroke patients who are unresponsive to intravenous rtPA.

Hemiplegic stroke patients are physically able to use only one arm and leg, those on the unaffected side, to propel and steer a manual wheelchair; therefore, it is difficult for them to use current manual wheelchairs. Although there have been a number of outstanding studies on wheelchair propulsion, very few have dealt with the wheelchair propulsion problems for stroke patients, whose propulsion styles are greatly different from users with healthy upper limbs. The purpose of this study was to develop a novel wheelchair for stroke patients based on their needs. A planar four-bar chain mechanism was introduced to develop the new wheelchair, and a clinical evaluation in a rehabilitation center was also done to evaluate the chair's usability. The prototype we developed allows stroke patients to use their legs and arms together to propel the wheelchair, and permits them to steer the wheelchair safely and efficiently. Eleven stroke patients with right hemiplegia were recruited to clinically evaluate the newly designed prototype, the unilaterally propelled wheelchair (UPW), in a comparison with a commercial two-handrim propelled wheelchair (TPW). The results revealed that the velocity, deviation frequency, and deviation period of the UPW were superior to those of the TPW. We concluded that it is easier, safer, and more efficient for hemiplegic stroke patients to use the UPW than the TPW. Relevance to industry The manual wheelchair has many demonstrable benefits for users who have mobility problems and sufficient upper-limb strength to propel one. However, it can be difficult for stroke patients to propel current manual wheelchairs. This study offers an innovative wheelchair, designed with the needs of hemiplegic stroke patients in mind, that offers improved efficiency and safety, thereby promoting independent living.

Purpose: This case report describes the effects of a new ankle foot orthosis with bi-channel adjustable ankle locks combined with physical therapy intervention on gait parameters in a subject with longstanding hemiplegia. Clinical Problem: A 69-year old male, 4.5 years post cerebrovascular accident with residual right hemiplegia, demonstrated impaired lower extremity muscle performance and motor control, with difficulty performing graded knee extension and achieving active knee flexion except in synergy, and slow gait (0.34 m/sec) with decreased left step time (0.57 sec) and length (26.3 cm) compared to the right (1.26 sec and 35.5 cm, respectively), decreased foot clearance during swing and knee hyper-extension during stance. Intervention: Collaboration between the PT and orthotist with attention to the subject's knee control and history of lower extremity edema determined orthotic prescription. The subjects then received 24 outpatient physical therapy visits over 11 weeks. Results: The new orthosis and PT intervention resulted in improved foot clearance, usual and fast velocity, with increased cadence, and better step length differential and step time differential at usual speed. Following physical therapy, muscle performance of quadriceps and hamstring improved, with no knee hyperextension during stance. The subject demonstrated increased confidence in gait and a positive attitude toward his right lower extremity. Conclusions: An appropriate orthosis combined with PT intervention can decrease energy expenditure in walking and increase confidence and attitude in a subject with longstanding hemiplegia

The case presented was a 40-year-old woman who received antivenin (polyvalent enzyme-refined globulin). She developed an immunological inflammation. The snake was a green pit viper and the antivenin was prepared in India. She manifested Brown-Sequard syndrome, confirmed by computerized tomography. It was manifested by right hemiplegia and absence of pain and temperature sensation on the left half of her body below the 4th rib. There was loss of vibration sense and joint position sense on the right side of the body. The neurological examination indicated a deficit at the level of C6. The follow up of the patient showed recovery after 2 years.

これまでの授業カリキュラムでは,高齢者の嚥下機能の低下と認知及び身体機能の障害を考慮した摂食・嚥下障害の学習と技術の根拠についての検討が十分ではなく,そのため,学外で高齢者の食事介護を多く行う学生が食事介護を実施する際に誤嚥,肺炎という事故が予測された。本学科では,学外実習前の学生に限られた指導時間の中で嚥下機能と障害そして介護を結びつけるための授業を行う必要があった。検討の結果,昨年まで授業では行っていない右片麻痺・嚥下障害疑似体験・介護体験の演習を計画した。この演習が学生に及ぼした学習について質的分析した結果,11のカテゴリーが抽出された。分析から障害疑似体験・介護体験は,困難経験の学習につながり,食事介助を行う側と受ける側の2つの側面から村象の理解を深めたと考えられた。学外実習前に行われた障害疑似者への食事介護体験をすることによって学生の思考は,障害のある利用者の身体的・精神的理解に進み,さらに,専門職種的思考の発展にまで及んでいたことが明らかになった。, There hasn't been enough discussion in the educational area for student of the course of human care & welfare based on the evidence relating to knowledge and skill about dysfunction of ingestion and deglutition with consideration for elderly patients who have dysfunction of deglutition, cognition and body functions. Previous studies suggested that care worker students might have risks to cause accidents relating to mis-deglutition or Pneumonia when they are in clinical training. There is a necessity to offer students a new project in order to combine their knowledge and care skills prior to their Clinical training. A plan was designed that helps students practice obstacle para-experience and care experience training for a patient who had right hemiplegia and deglutitive dysfunction. It never has been offered in in-school practice. Questionnaires were distributed to explore what this new practical project gave students. Eleven major categories were extracted from the responses of students. It was revealed that students gained physical and psychological understanding for patients who had dysfunctions through the new practice. It was suggested that students understand both points of views as care givers and care takers. It was also suggested that the new project was effective as students developed the thought as a specialist.

A 38-year-old woman presented after 2 weeks with penetrating craniocerebral injury from a six inch nail. She had aphasia and right hemiplegia. Brain CT scan showed no significant cerebral injury. The nail track was infected. Craniectomy and extraction of the nail along with broad spectrum antibiotics was effective. She had no residual neurologic deficit.

We present a series of 125 postmenoppausal women treated with tibilone and followed-up for 9 years. Mean age was 52 years (range 27-67), mean parity was 2.35 (range 0-6), mean age at the menopause was 46.46 years (range 26-58), mean years of treatment was 4.14 (range 1-8). The results obtained were: bleeding, spotting in 11 cases (8.8%) and metrorrhagias in 2 cases (1.6%); breast tenderness 4 cases (3.2%), increased weight 15 cases (12%), hirsutism 17 cases (13.6%). The serious incidents were 2 cases of breast cancer (1.6%), 1 meningioma (0.8%), and 1 right hemiplegia (0.8%). Treatment was withdrawn in 36 cases (28.8%) with the level corrected. No significant differences were seen in endometrial thickness, using vaginal sonography, between the first and last measurement. Nor were there differences in the values of total cholesterol, HDL, LDL, VDL, triglycerides, or in the transaminases GOT and GPT. Tibilone is effective in the treatment of climacteric syndrome. Libido improved in 4 cases (4%).

Handwriting is a major occupational task for children attending mainstream schools in Australia, including children who have hemiplegia and attend their local school. A preliminary exploratory study was undertaken at the Crippled Children's Association of South Australia to determine the prevalence of handwriting difficulties in this population, as there is little information published on their specific abilities. The handwriting abilities of 42 primary school children with hemiplegia were surveyed, with replies gained from 31 parents and 25 teachers. Results indicate that parents report 75% of children have handwriting problems while teachers report 69% of children have difficulty. Greatest difficulty was reported with the ability to write from dictation, or to maintain neatness over long periods of time or at speed. Children with right hemiplegia, boys, and those having coexisting conditions experienced more generalised problems. Also noted to impact on performance was variability in the children's abilities from one day to the next.

We reported a case of rheumatoid arthritis (RA) with asymmetrical manifestation of wrist arthropathy in a hemiplegic stroke patient. The patient was a 61-year-old woman who had a left thalamic hemorrhage and now suffered right hemiplegia. Six months after her apoplectic stroke she complained of left wrist pain. X-ray examination indicated that her left wrist joint was destroyed. The sparing effect was observed in her paralyzed right wrist. The test for serum rheumatoid factor was positive and the patient's inflammatory signs were elevated. Consequently, she was administered anti-rheumatic drugs and fitted with a left wrist orthosis and her left wrist pain diminished. We also discuss the mechanism of unilateral RA.

Summary We report the case of a pregnant woman presenting with a paradoxical air embolism following the disconnection of a central venous catheter. Secondary right hemiplegia associated with a confusional state justified emergency hyperbaric oxygen therapy, which was followed by complete neurological recovery. The aim of this case report is to assess risk situations of gas embolism during pregnancy and postpartum period, and also the indications for and foetal effects of hyperbaric oxygen therapy.