Pure monoparesis: a particular stroke subgroup?
BACKGROUND
Acute stroke presenting as monoparesis is rare, with a pure motor deficit in the arm or leg extending to an isolated facial paresis.


OBJECTIVE
To raise the question if acute stroke presenting as monoparesis is a different entity from stroke with a more extensive motor deficit.


METHODS
In the Lausanne Stroke Registry (1979-2000), 195 (4.1%) of 4802 patients met the clinical criteria for pure monoparesis involving the face (22%), arm (63%), or leg (15%).


RESULTS
In the vast majority of cases (> 95%), monoparesis corresponded to ischemic stroke with a favorable outcome, with initial computed tomography scans or magnetic resonance images showing no signs of hemorrhage. The lesion for a facial deficit was most frequently located subcortically (internal capsule); for an arm deficit, in the superficial middle cerebral artery; and for a leg deficit, in the anterior cerebral artery territory. In pure monoparesis, only 17% of the patients had more than 1 risk factor as compared with 26% of those with bimodal and trimodal hemiparesis and with 46% of all patients with stroke other than those with pure motor stroke. The only frequent risk factor was hypertension (53%); however, this frequency was no different from that in other patients with stroke. No major stroke etiology could be identified in any of the 3 subgroups of monoparesis.


CONCLUSIONS
Our finding of a wide range of stroke localization and etiology in monoparesis without any particular subgroup suggests that no specific plan of investigation can be recommended for these patients.
Maeder-Ingvar
Malin
M
Department of Neurology, University Hospital of Vaud, Lausanne, Switzerland. Malin.Maeder-Ingvar@chuv.hospvd.ch
van Melle
Gus
G
Bogousslavsky
Julien
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020771:Anterior Cerebral Artery / Q000473:pathology / Q000503:physiopathology; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005145:Face / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D020772:Internal Capsule / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D007866:Leg / Q000294:innervation / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed