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76: Acute Hemiparesis
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Published:May 2023
Karen Hardy Brandstaedter, MD, FAAP, Yocheved Lindenbaum, MD, FAAP, "Acute Hemiparesis", Caring for the Hospitalized Child: A Handbook of Inpatient Pediatrics, American Academy of Pediatrics Section on Hospital Medicine, Jeffrey C. Gershel, MD, FAAP, Daniel A. Rauch, MD, FAAP, SFHM
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Acute hemiparesis, or unilateral weakness, can be the presenting symptom of many neurologic diseases. The most concerning are pediatric stroke and intracranial hemorrhage (ICH). The diagnosis of stroke is often delayed due to subtleties in presentation, especially in younger children. In addition, “stroke mimics” such as seizure, infection, and migraine are common in children.
Anatomically, hemiparesis typically implicates the contralateral corticospinal tract, which travels from the cortex through the internal capsule to the medulla, where it decussates contralaterally and descends in the lateral spinal cord. It then synapses on the anterior horn cells, which give rise to the peripheral nerves....
