Welcome to my neuro blog. This will contain information related to health and wellness, especially concerning neurological disorders. The articles and cases on this blog would benefit a neurologist or a doctor of other speciality too. It would be useful for general public as well as healthcare professionals.
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CORONA VACCINE: Who gets it first? Who pays?
CORONA VACCINE: Who gets it first? Who pays? Most countries are involved in research into developing a vaccine against corona virus infection (causing COVID-19). The vaccine is likely to be available soon (in a few months from now). However, there are many logistical challenges that need to be considered and planning done well in advance… Read more
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OFATUMUMAB is MORE effective than TERIFLUNOMIDE in MULTIPLE SCLEROSIS
OFATUMUMAB is MORE EFFECTIVE than TERIFLUNOMIDE in MULTIPLE SCLEROSIS Multiple sclerosis (MS) is an autoimmune demyelinating disorder affecting optic nerves, brain and spinal cord. Treatment includes disease modifying treatments (DMTs) to reduce the number of relapses. In a recent study, ofatumumab was compared with teriflunomide in patients with relapsing remitting multiple sclerosis. Ofatumumab is an… Read more
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ANGIOEDEMA AFTER tissue PLASMINOGEN ACTIVATOR INFUSION
A 78-year old man presented with left hemiparesis of 90 minutes duration. A diagnosis of right MCA territory infarct was made and he was started on tissue plasminogen activator infusion for thrombolysis. 54 minutes after starting infusion, he developed swelling involving left side of tongue. t-PA infusion was stopped. A diagnosis of oro-lingual edema was… Read more
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Best Chance Against Corona is by Not Getting This Infection
Best Chance Against Corona is by Not Getting This Infection Dr Sudhir Kumar MD DM Corona Virus Disease- 2019 (COVID-19) is caused by a corona virus, named SARS CoV2. It started in China in late 2019 and has rapidly spread all over the world, including India. COVID-19 is highly contagious It is highly contagious and… Read more
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BE CAUTIOUS WHILE USING HCQ FOR TREATING COVID-19 IN MYASTHENIA GRAVIS
BE CAUTIOUS WHILE USING HCQ FOR TREATING COVID-19 IN MYASTHENIA GRAVIS Hydroxychloroquine (HCQ) is anti-malarial drug, which is commonly used for treating rheumatological disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). HCQ has been recommended for prophylaxis as well as treatment of COVID-19 infection. Myasthenia gravis (MG) is an autoimmune disorder resulting… Read more
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YOGA AS ADD ON THERAPY IS SUPERIOR TO MEDICAL THERAPY ALONE IN MIGRAINE
Yoga as ADD-ON Therapy is Superior to Medical Therapy alone in Patients Suffering from Migraine Dr Sudhir Kumar MD DM Migraine is the commonest cause of headache, especially affecting young people, more common in women. Migraine leads to disability and is a leading cause of absence from work. The mainstay of migraine treatment is medical… Read more
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UNEXPECTED AND UNINTENDED BENEFITS OF LOCKDOWN
“UNEXPECTED & UNINTENDED BENEFITS” OF LOCKDOWN Dr Sudhir Kumar MD DM Apollo Hospitals, Hyderabad 25th May 2020 COVID-19 caused by SARS CoV2 virus is a pandemic that started from China and rapidly spread to about 200 countries worldwide. In the absence of a vaccine, strict lockdown was imposed in March 2020 to prevent a sudden… Read more
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Olfactory Bulb Edema in a Patient with Loss of Smell due to COVID-19 infection
Loss of smell (anosmia) and loss of taste (dysgeusia) have been commonly noted in people with COVID-19 infection, including those without any other symptoms such as fever, cough or breathing difficulty. In a recent case, anosmia developed on day 7 of infection. MRI showed edema (swelling) and increased signal of olfactory bulbs and tracts. Patient… Read more
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FACIAL PARALYSIS AS A NEUROLOGICAL MANIFESTATION OF COVID-19 INFECTION
About a third of COVID-19 patients have neurological manifestations. These include headache, dizziness, loss of smell, delirium, stroke, Guillain-Barre syndrome, meningitis and encephalopathy. Recently a case of facial paralysis was reported from Singapore (with a travel history from Spain). 27-year old man was admitted with myalgia, cough, headache and fever for 4 days. RT PCR… Read more
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SMOKING REDUCES THE RISK OF PARKINSON’S DISEASE (PD)
Smoking is a risk factor for many non-communicable diseases, such as heart attacks, strokes, cancers, chronic obstructive lung diseases, liver disease, diabetes and pneumonia. It is expected to cause 1 billion deaths in 21st century. However, it has one benefit. In a long term study, smokers were found to have lower occurrence of Parkinson’s disease… Read more
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GENERALIZED MYOCLONUS IN COVID-19
COVID-19 presents with various neurological manifestations in about 37% of patients. A recent report from Spain described generalised myoclonus in 3 patients with COVID-19. Patients were in older age group and had usual symptoms of COVID-19 such as fever, cough, breathing difficulty and anosmia at admission. Myoclonus developed in the second week of illness, characterised… Read more
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Life During COVID Times: A New Normal
Life during COVID Times: A New Normal?Dr Sudhir Kumar COVID-19 caused by SARS CoV2 virus is a pandemic, which started from China in December 2019, and since has rapidly spread to around 200 countries. After China, many European countries such as Italy, Spain and France saw huge numbers of COVID-19 cases and deaths due to… Read more
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Focal Status Epilepticus as a Presenting Symptom of SARS CoV2 Infection
Focal Status Epilepticus as a Presenting Symptom of SARS CoV2 Infection COVID 19, caused by SARS CoV2 virus is a global pandemic and has affected more than 3 million people worldwide. Most patients with COVID 19 present with respiratory symptoms, however, neurological involvement is not uncommon. Previously, stroke, Guillain Barre Syndrome, meningitis and encephalitis have… Read more
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LARGE VESSEL STROKE AS PRESENTING FEATURE OF COVID-19
Large Vessel Stroke as Presenting Feature of Covid 19 Dr Sudhir Kumar MD DM, Consultant Neurologist, Apollo Hospitals, Hyderabad drsudhirkumar@yahoo.com COVID-19 caused by SARS CoV2 is a global pandemic, which has affected about 3 million people worldwide, and has resulted in more than 2,00,000 deaths. Respiratory system seems to be the main target of COVID-19… Read more
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COVID-19 IN INDIA: WHAT AFTER LOCKDOWN
Covid-19 in India: What after Lockdown Covid-19 pandemic, which started from China in December 2019, rapidly spread to about 200 countries, affecting about 3 million people, resulting in more than 2,00,000 deaths. In India, the first case was reported on January 30th, 2020. Three months later, as on 26th April 2020, there have been a… Read more
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Headaches Associated with Personal Protection Equipment (PPE)
HEADACHES ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT Dr Sudhir Kumar MD DM Consultant Neurologist Apollo Hospitals, Hyderabad drsudhirkumar@yahoo.com Introduction Coronavirus disease 2019 (COVID-19) caused by SARS-CoV2 is a global pandemic, which has already affected about 2.6 million people in about 200 countries. Healthcare workers working in high-risk areas (such as emergency room, isolation wards, ICU, etc)… Read more
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SARS CoV2 INFECTION IN PREGNANT WOMEN: Clinical Features and Outcome
Covid 19 in Pregnancy: Clinical Features and Outcome Dr Sudhir Kumar MD DM drsudhirkumar@yahoo.com Covid 19, caused by SARS CoV2 virus is a global pandemic, which has infected more than 2.2 million people worldwide and resulted in death of about 1,50,000 people. Data regarding the effects of Covid 19 in pregnant women are lacking. A… Read more
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PHYSICAL THERAPY is better than STEROID INJECTION for KNEE OSTEOARTHRITIS
PHYSICAL THERAPY is BETTER than STEROID INJECTION for KNEE OSTEOARTHRITIS Osteoarthritis (OA) of knees is a common disease, affecting people in their middle and old ages. The commonest symptom is knee pain, which increases on standing and walking. OA is a common cause of disability. Treatment for OA includes: 1. Pain killer medicines, 2. Steroid… Read more
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HOW DOES COVID 19 AFFECT THE NERVOUS SYSTEM
How does COVID 19 affect Nervous System? Covid 19, caused by SARS CoV2 virus, is a global pandemic, which has infected about 1.88 million people in about 200 countries, resulting in about 1,16,800 deaths. Covid 19 predominantly affects respiratory system. Common symptoms include fever, cough, breathing difficulty, fatigue and chest pain. Severe cases manifest with… Read more
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SMARTPHONE USE and PRIMARY HEADACHES
Smartphone use has increased over time. Smartphone is used for multiple functions other than phone, such as browsing internet, playing games, watching movies/videos, chatting, as a camera, etc. Life without smartphone is unimaginable. The impact of smartphone use on primary headache syndromes is not well known. In a recent research study, headache characteristics were compared… Read more
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GUILLAIN BARRE SYNDROME as a presenting feature of SARS CoV 2 INFECTION
Introduction Guillain Barre syndrome (GBS) refers to an acute onset polyradiculoneuropathy, which commonly manifests with rapidly progressive weakness of all 4 limbs, usually starting in lower limbs, then ascending to involve upper limbs. Muscle tone is reduced (hypotonia) and the deep tendon reflexes are either sluggish or absent. Minor sensory symptoms such as distal paresthesia… Read more
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COVID 19 TESTING: INDIA VERSUS THE REST- WHERE DO WE STAND?
COVID 19 TESTING: INDIA VERSUS THE REST- WHERE DO WE STAND? Covid 19, a global pandemic, which began in China in late December 2019, has spread to more than 200 countries in the world. The total numbers of Covid 19 infected people have been rapidly increasing in some countries such as USA, UK, Italy, Spain,… Read more
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INDIA AS A SUPPLIER OF HCQ TO REST OF THE WORLD: JUSTIFIED OR NOT?
INDIA AS A SUPPLIER OF HCQ TO REST OF THE WORLD: JUSTIFIED OR NOT? There has been a lot of criticism of PM Modi after a ban on export of HCQs were lifted and India agreed to supply HCQ to US and other countries. However, is this criticism justified?First, let us look at Indian pharmaceutical… Read more
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WOMEN FIGHT COVID 19 BETTER THAN MEN
WOMEN FIGHT COVID 19 BETTER THAN MEN It is no secret that males are the weaker gender in many aspects. On an average, men die younger than women and the prevalence of life threatening diseases such as heart attacks; stroke and cancer are more in men than in women. The same holds true with respect… Read more
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ALCOHOL CONSUMPTION AND CORONA VIRUS DISEASE
ALCOHOL CONSUMPTION AND CORONA VIRUS DISEASE Alcohol use is a global health concern, ranking seventh among the leading causes of death and disability. Alcohol consumption is associated with many serious illnesses including liver cirrhosis, dementia, cerebellar ataxia, nutritional deficiency, etc and it is also a major risk factor for road traffic accidents. Despite these health… Read more
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ANOSMIA, HYPOSMIA AND DYSGEUSIA can be the First Symptoms of Covid 19
Loss of Smell and Taste Could be Early Symptoms of Covid 19 The typical symptoms of Covid 19 are fever, cough and breathing difficulty. However, several cases have been reported, where patients presented with lack of smell and taste, who were later diagnosed to be having Covid 19. Many of these patients had no respiratory… Read more
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Hydroxychloroquine (HCQ) for Covid 19 Prevention
Chloroquine and Hydroxychloroquine: Should you take them for Covid 19 Prevention? Chloroquine is routinely used in the treatment of malaria. Hydroxychloroquine (HCQ) is used for treating malaria and rheumatological disorders such as rheumatoid arthritis, systemic lupus erythematosus, etc. Recently they have been in news with regards to their proposed role in preventing Covid 19 infection… Read more
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Useful Information on COVID 19 Infection
Useful Information on Covid 19 Infection Caused by SARS-CoV2 Covid 19 infection caused by the SARS-CoV 2 virus has become a global pandemic. It started in China in late December 2019 and has rapidly spread to many countries across the world. As of now, the overall trends show an increase in the total number of… Read more
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MRI BRAIN in a Case of Cardio-embolic Stroke
Cardio-embolic strokes refer to infarcts in brain due to embolism from heart. Typically, infarcts in cardio-embolic strokes involve multiple arterial territories. In the MRI shown above, we can see multiple acute infarcts in bilateral anterior as well as posterior circulation territories. This patient was a 60 year old lady, with patent foramen ovale (PFO) and… Read more
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COVID 19 (Corona Virus) RELATED ANXIETY DISORDER
Corona (Covid 19) Related Anxiety Disorder Corona virus infection, better known as Covid 19 infection, which started in China about three months ago, has rapidly spread to about 150 countries. So far, about 1,50,000 people have been infected with Covid 19, out of whom about 5,500 people have died. Various forms of media (including TV,… Read more
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FOCAL DYSTONIA-WRITER’S CRAMP
Writer’s cramp is among the most common focal dystonias. Patients with writer’s cramp have a task-specific dystonia, which occurs while writing. Patients with writer’s cramp face severe handicap and disability in their jobs or education, as they are unable to write properly. A diagnosis of writer’s cramp can be made on the basis of history… Read more
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Incidental Pineal Cyst on MRI Brain
Pineal cysts may be incidentally noted on MRI brain. A pineal cyst is called “incidental” if it does not produce any symptoms or signs. In a large series of >42,000 MRI brains, incidental pineal cysts were noted in 281 (0.67%) patients. About two-thirds of them were females. The mean size of incidental pineal cyst was… Read more
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Incidental Saccular Aneurysm in Brain
Aneurysms are incidentally detected when brain imaging is done for indications other than subarachnoid hemorrhage. The most common indication for brain MRI/MR Angiogram is stroke. It is also done in people who have a high risk of getting brain stroke in future (on account of risk factors and family history). In our case, a 45-year… Read more
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“Dawson’s Fingers” on MRI Brain in Small Vessel Ischemia
Dawson’s fingers refer to the periventricular white matter lesions, which extend perpendicular to the lateral ventricles and/or callosal junction. These represent perivenular inflammation, and are hallmarks of multiple sclerosis (MS), a demyelinating disorder of brain, optic nerves and spinal cord. Dawson’s fingers, however, can be seen in conditions other than MS too. The commonest condition… Read more
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External Brain Herniation 4 Months after Decompressive Hemicraniectomy
Decompressive hemicraniectomy (DH) is a life-saving surgery, performed in cases of severe mass effect due to stroke (ischemic or hemorrhagic) or head trauma. The skull bone overlying the affected cerebral hemisphere is removed (and stored in a “bone bank”). Decompressive hemicraniectomy is generally safe, however, it could be associated with complications in a few cases.… Read more
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Resting Tremors of Right Hand in Parkinson’s Disease
Resting tremors are a hallmark of Parkinson’s disease (PD). Tremors start on one side of the body affecting upper limb more severely than the lower limb. After 3 years or in some cases even longer, tremors become symmetric involving the other side. In this case, the patient continued to have only right-sided tremors even 7… Read more
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Occurrence of New-onset Oro-facial Dyskinesia after starting LEVOSULPIRIDE
This gentleman was being treated for Parkinson’s disease for several years and was doing well on medications. However, he presented with recent worsening of Parkinsonian symptoms. In addition, he had developed new onset orofacial dyskinesias, which he did not have before. These new symptoms developed after he was started on levosulpiride for his stomach-related ailment.… Read more
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MRI BRAIN Abnormalities in a Case of Spinocerebellar Ataxia (SCA)
Spinocerebellar ataxia (SCA) comprises of a group of neurodegenerative disorders characterized by progressive cerebellar ataxia (either alone or in combination with other neurological system involvement). They are currently classified into various subtypes based on the underlying genetic defect. Currently, there are about 40 subtypes of SCA, referred to as SCA 1, SCA2, ….SCA 40. MRI… Read more
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Noncontrast CT Brain in Cerebral Venous Sinus Thrombosis
Cerebral venous sinus thrombosis (CVST) commonly presents with headache, raised ICP, seizures and focal neurological deficits. Diagnosis can be made on the basis of CT and MRI brain. The usual initial investigation done is CT brain-plain (non-contrast). It is important to pick up the findings on plain CT so that an early diagnosis can be… Read more
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TRIGEMINAL NEURALGIA- Description of Symptoms
Trigeminal neuralgia (TN) is among the commonest causes for episodic facial pain. It commonly affects one side of face, however, in some patients, both sides of face may get affected. Here, we have a patient suffering from left sided trigeminal neuralgia, describing her symptoms. Pain is episodic, shock-like, lasting for a few seconds. Pain is… Read more
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MRI BRAIN FINDINGS IN STURGE-WEBER SYNDROME
Sturge-Weber syndrome (SWS) is a sporadic phakomatoses and is characterized by angiomatosis of skin, eye and meninges. . Patients present with epilepsy and developmental delay since childhood. Clinical examination reveals reddish discoloration of face (referred to as port wine stain), sclera and limbs, usually on one side of body. Imaging findings of SWS are typical.… Read more
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Bilateral (Cerebral) Ptosis due to Right Hemispheric Stroke
Ptosis refers to drooping of eyelids. Ptosis occurs due to weakness of levator palpebrae superioris, the muscle responsible for eyelid elevation. Ptosis can occur due to a variety of causes, including nuclear, infranuclear and supranuclear causes. The commonest causes of ptosis are infranuclear due to involvement of oculomotor nerve (3rd nerve palsy), the LPS muscle… Read more
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MYOCLONIC JERKS secondary to POST-CARDIAC ARREST CEREBRAL HYPOXIA
This patient suffered “out of hospital” cardiac arrest. Cardio-pulmonary resuscitation (CPR) was done for about 30 minutes, after which cardiac rhythm was restored. Patient remained comatose after resuscitation. He was on life supports including mechanical ventilation and multiple inotropes. He had frequent myoclonic jerks. Note that the myoclonic jerks are asymmetric, affecting mainly the left… Read more
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POLYMINIMYOCLONUS
Polyminimyoclonus refers to involuntary, jerky, small amplitude, tremor-like movements, most commonly seen in hands. The commonest cause is degenerative anterior horn cell disease, commonly known as motor neuron disease or amyotrophic lateral sclerosis. These tremor-like movements (polyminimyoclonus) correspond to fasciculations in forearm muscles.
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HEMIPLEGIC GAIT
A person with left spastic hemiparesis. Note the flexion at elbow with internal rotation of left upper limb. The lower limb too has extension at left hip and left knee. While walking he circumducts the left lower limb (external rotation with movement in an arc).
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PSYCHOGENIC NONEPILEPTIC SEIZURES
Psychogenic non-epileptic seizures (PNES) are common in clinical practice. The diagnosis of PNES is commonly missed or delayed. The diagnosis of PNES should be suspected, if a person has repeated seizures despite being on good anti-epileptic drugs. Other features that help in accurate diagnosis of PNES are: 1. The semiology of non-epileptic seizure is unlike… Read more
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Extensive CEREBRAL VENOUS SINUS THROMBOSIS with COLLATERAL formation
35-year old gentleman presented with episodes of headache for the past two weeks. There were no other significant past history. CT brain showed features of 1. Right transverse sinus thrombosis (red arrow), 2. Internal cerebral veins thrombosis (thin yellow arrow), 3. Straight sinus thrombosis (orange arrow), 4. Superior sagittal sinus thrombosis (thick yellow arrow) MR… Read more
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ESSENTIAL TREMORS affecting ONE Arm and Head
Essential tremors (ETs) are the commonest causes of tremors, along with Parkinson’s disease (PD). It is usually thought that tremors affecting one hand are typical of PD, and in ET, tremors affect both hands. However, in clinical practice, it is not unusual to see patients with ET, who have tremors affecting only one hand. The… Read more
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Jaw Tremors and Asymmetric hand Tremors in a Case of Essential Tremors
A 65-year old lady presented with six years history of tremors affecting both upper limbs, left more than right. I had periodically seen her during these 6 years. Tremors were of postural type and affected left upper limb more than the right upper limb. She developed jaw tremors for the past 3-6 months, which were… Read more
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HEMIPLEGIC GAIT
Hemiplegia refers to weakness of one half of the body, mostly affecting the upper and lower limbs. In the acute phase, there is hypotonia and weakness of affected limbs. As recovery occurs over the next few days to weeks, muscle tone increases, resulting in spasticity. In this video, you can see the hemiplegic gait, affecting… Read more
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