Existence of Ipsilateral Hemiparesis in Ischemic and Hemorrhagic Stroke: Two Case Reports and Review of the Literature

Abstract

Supratentorial stroke presenting as contralateral hemiparesis is predominantly related to contralateral projection of the corticospinal tract. While most corticospinal fibers decussate at the level of the medulla, some tracts continue descending as ipsilateral ventral corticospinal fibers. In this systematic review of the literature and 2 case reports specifically seen in our institute, we describe the presence of ipsilateral hemiparesis in ischemic and hemorrhagic stroke patients. We compiled available information about the existence of uncrossed corticospinal tracts and/or the presence of bilateral operating motor cortical networks. There was an association in patients with congenital uncrossed corticospinal tracts and posterior fossa malformations. There was also a high correlation of ipsilateral hemiparesis in patients with remote infarction. A previous stroke was seen in 50% of the patients, all except for 1 case were ischemic in nature. Patients with previous infarcts do demonstrate an adaptive compensation for damaged or disconnected regions of an injured area. This emphasizes the need to consider the investigation for previous infarctions or underlying genetic structural defects by using certain imaging modality.

Ipsilateral hemiparesis in ischemic stroke patients

“…Cases of ipsilateral hemiparesis or deterioration of hemiparesis ipsilateral to the cerebral injury are known; to the best of our knowledge, there are reports of 17 such patients (Table ). Ipsilateral hemiparesis is hypothesized to be caused by injury to the uncrossed corticospinal tract in patients without decussation of the corticospinal tract, injury to the uncrossed corticospinal tract acquired after prior brain injury, injury to the ipsilateral extrapyramidal motor pathway or premotor cortex, or transhemispheric diaschisis from the affected side …”

Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct

“…Ipsilateral hemiparesis caused by supratentorial stroke is rare, and there are only 10 cases reported up to now 1. Nearly 50% of the patients had remote infarcts previously 1.…”

“…Nearly 50% of the patients had remote infarcts previously 1. Almost all the published articles reported the ipsilateral hemiparesis.…”

“…Ipsilateral hemiparesis caused by supratentorial stroke is rare, and there are only some case reports, and no population based series were found 1. There are some reasons for the ipsilateral hemiparesis, of which the cortical reorganization within the motor areas of the unaffected hemisphere is important for the rehabilitation of the stroke patients 2.…”

Identification of autophagy signaling network that contributes to stroke in the ischemic rodent brain via gene expression

“…Ischemic stroke is one of the major causes of death and disability [1][2][3][4][5] . It is generally considered to be a heterogeneous and multifactorial disorder and caused by both conventional environmental risk factors and genetic factors [6,7] .…”