EpistemisHemiparesis
Specialty: Neurology.
Why it occurs
- Acute ischemic stroke or parenchymal intracerebral hemorrhage
- Primary or metastatic brain tumor (subacute progression with mass effect)
- Brain trauma with subdural or epidural hematoma
- Demyelinating outbreak in the context of multiple sclerosis
- Todd's palsy after a focal motor epileptic seizure (transient deficit)
- Central nervous system infection (brain abscess, focal encephalitis)
Initial workup
Urgent simple cranial CT (to differentiate ischemia from hemorrhage immediately) or brain MRI with diffusion sequences (DWI); Angio-CT or Angio-MRI to assess intracranial and extracranial vascular permeability; electrocardiogram and echocardiogram to rule out cardioembolic sources; analysis with coagulation.
red flags
Sudden onset weakness of one hemibody, especially if associated with deviation of the corner of the mouth, speech alteration (aphasia/dysarthria), loss of vision in one eye or hemihypoesthesia, which constitutes a direct suspicion of acute stroke within the therapeutic window of reperfusion (code stroke).
Standard management
- Recombinant tissue plasminogen activator / Alteplase — 0.9 mg/kg IV if inclusion criteria for ischemic stroke within the first 4.5 hours are met
- Tenecteplasa
- Acetylsalicylic acid — 100-300 mg/day as an antiplatelet agent if bleeding has been ruled out
- Atorvastatin (80 mg/day).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 6
- Treatment options
- 4