EpistemisMonoparesis
Specialty: Neurology.
Why it occurs
- Focal cortical stroke (e.g., ischemia in the territory of the middle or anterior cerebral artery with selective somatotopic representation)
- Acute compressive mononeuropathy (e.g., radial nerve palsy from compression of the humerus, common peroneal nerve palsy from crossing the legs)
- Acute compressive cervical or lumbosacral radiculopathy (selective disc herniation)
- Brachial or lumbosacral plexopathy (traumatic, neoplastic infiltrative or inflammatory Parsonage-Turner type)
- Psychogenic monoparesis/functional neurological symptoms disorder
Initial workup
MRI or CT brain to rule out a contralateral lobar ischemic or hemorrhagic event; electromyogram (EMG) and nerve conduction velocity of the affected limb (performed after 14-21 days if radiculopathy or plexopathy is suspected to demonstrate denervation); ultrasound of the peripheral nerve or MRI of the corresponding plexus if infiltrative pathology is suspected.
red flags
Sudden onset monoparesis in an arm or leg without local pain but associated with mild dysarthria, facial asymmetry or high cardiovascular risk factors, indicative of a minor cortical ischemic stroke that requires urgent evaluation in a stroke unit.
Standard management
- Acetylsalicylic acid — 100 mg/day if cerebral ischemic etiology is confirmed
- Gabapentin — 300-1800 mg/day for neuropathic pain associated with radiculopathies or plexopathies
- Pregabalin — 75-300 mg/day
- Oral corticosteroids in the acute phase of inflammatory plexopathy (Parsonage-Turner syndrome).
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
- 5
- Treatment options
- 4