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The main cause of motor weakness is damage to the primary crossed corticospinal tract. Most patients with stroke (80%-90%) have motor symptoms or signs. Hemiparesis with uniform weakness of the arm and leg associated with hemisensory deficit and speech deficit (dysphasia or dysarthria) usually indicates a large supratentorial lesion that involves the middle cerebral artery (MCA). Such patients have more severe weakness than do those with isolated hemiparesis. Crossed brainstem syndromes, well known with eponyms, are characterized by palsy of one of the 12 cranial nerve pairs associated with a contralateral neurological deficit due to involvement of the neurological long tracts (mainly motor or sensory). The integrity of all motor tracts, with the pyramidal tract as the main descending fiber bundle, but also the corticorubrospinal and corticoreticulospinal systems, appears to account for stroke recovery in a recent in vivo diffusion tensor imaging (DTI) study in chronic stroke patients.
This chapter describes right-sided numbness using the case of an 82-year-old woman who had a former history of hypertension, type 2 diabetes treated with oral hypoglycemic agents, rheumatoid arthritis, dysthymic disorder, and left dorsal herpes zoster with residual postherpetic neuralgia. The physical examination showed a conscious patient with moderate motor aphasia, right homonymous hemianopsia, and balanced faciobrachiocrural hemiparesis in association with hemihypoesthesia of the right hemibody. The brain magnetic resonance imaging (MRI) scan showed acute cerebral ischemia in the territory of the left middle cerebral artery. A diagnosis of cerebral infarction of cardioembolic origin was made. A final tentative diagnosis of vascular cognitive impairment that fulfilled criteria of multi-infarct dementia was established. Living performance after stroke was severely impaired and home assistance for daily living activities was needed. Treatment for the cognitive impairment includes speech therapy and physical rehabilitation.