Ipsilateral hemiparesis in ischemic stroke patients.
OBJECTIVE
To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients.


METHODS
Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI.


RESULTS
Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine.


CONCLUSIONS
Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system.
Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Y
Y
Inatomi
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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M
Nakajima
Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
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T
Yonehara
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Y
Y
Ando
D000328:Adult; D000368:Aged; D019054:Evoked Potentials, Motor; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011712:Pyramidal Tracts / Q000503:physiopathology; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation
cerebrovascular diseases; ipsilateral hemiparesis; strokes