| 1. The paralysis is limited to one side of the
body. |
1. The paralysis is not always
limited to one side of the body. This particularly applies to
paralysis of the face, in which the symptoms are generally
bilateral |
| 2. The paralysis is not systematic, e. g., if
unilateral movements of the face are very much weakened, this
weakness appears quite as distinctly on the hemiplegic side
during the execution of synergic bilateral movements. |
2. The paralysis is sometimes
systematic. It is almost so in the face, e. g., unilateral
movement of the face may be completely abolished, while the
muscles on the hemiplegic side act normally during the execution
of synergic bilateral movements. |
| 3. The paralysis affects the conscious voluntary
movements as much as the unconscious or subconscious voluntary
movements, giving rise to the platysma sign (more energetic
contraction of the platysma on the sound side in the act of
opening the mouth or bending the head in opposition to the
resistance which the observer makes to this movement), combined
flexion of the thigh and trunk, and in walking the absence of
active swinging of the arm, as contrasted with the exaggeration
of passive swinging (the limb oscillating as an inert corp when
the patient suddenly turns around). |
3. The unconscious or subconscious
voluntary movements are not affected; with the result that there
is an absence of platysma sign, and of combined flexion of the
thigh and trunk; active swinging of the arm may be absent, but
there is no exaggeration of the passive movement. |
| 4.The tongue is usually slightly deviated to the
side of the paralysis. |
4. The tongue is sometimes slightly
deviated to the side of the paralysis, but the deviation may be
very pronounced or be directed to the opposite side of the
paralysis. |
| 5. There is, chiefly at the onset, muscular
hypotonus, which may be shown in the face by obliteration of the
naso-labial fold and the lowering of the eyebrow, and in the
upper limb by exaggerated passive flexion of the forearm, and by
the sign of pronation (the hand when left to itself assumes a
position of pronation). |
5. There is no muscular hypotonus.
When there is facial asymmetry, it will be found to be due to
muscular hypotonus, but to spasm; the sign of exaggerated
flexion of the forearm and the sign of pronation are
absent. |
| 6. The tendon and bone reflexes are frequently
affected at the onset, when they may be lost, diminished or
exaggerated. Later, they are usually exaggerated and in many
cases there is clonus foot. |
6. The tendon and bone reflexes
show no change; there is no clonus foot. |
| 7. The cutaneous reflexes are generally affected.
The abdominal reflex and cremasteric reflex are usually
diminished or lost, especially at first. The character of the
reflex movement of the toes following stimulation of the sole
usually undergoes inversion; the toes, and especially the great
toe, instead of being flexed, become extended on the metatarsus
(toe phenomenon). Extension of the great toe is often associated
with abduction of the other toes (fan sign). Exaggeration of the
reflexes of defense may sometimes be noted. |
7. The cutaneous reflexes do not
appear to be affected. The abdominal and cremasteric reflexes
are normal. The reflex movement following stimulation of the
sole does not undergo inversion. The toe phenomenon and fan sign
are absent. The reflexes of defense are not exaggerated. |
| 8. The form of contracture has particular
characteristics and cannot be reproduced by a voluntary
contraction of the muscles. There is a “clawing” of the hand,
which gives the sensation of an elastic resistance automatically
increased during passive movements of extension of the
fingers. |
8. The form of contracture may be
reproduced by a voluntary contraction of the muscles. |
| 9. The course is regular, contracture succeeding
flaccidity. The disappearance of the motor disturbance, when it
does take place, is progressive. The paralysis shows no tendency
to become better and worse alternately (permanence of motor
troubles). |
9. The course is capricious; the
paralysis may remain flaccid indefinitely, or it may be spastic
from the first; spastic phenomena are sometimes associated with
paralysis, especially in the face. The symptoms are frequently
liable to subside and to get worse alternately, to become
rapidly modified in their intensity as well as in their form,
and to present transitory remissions which may last only a few
moments (variety of motor troubles). |
| Other signs of organic hemiplegia |
| 10. Raimiste's sign, which is observed
during the period of flaccidity. It is obtained as follows:
place the paralysed forearm and hand in a vertical position,
with the elbow resting on the table. It will be found that if
the hand be left to itself, it will become rapidly flexed and at
the same time pronated. |
| 11. The interossei phenomenon described
by Souques: movement of extension and abduction of the fingers
whenever the patient raises the affected arm. |
| 12. Klippel-Weil's sign: involuntary
flexion of the thumb accompanying passive straightening of the
flexed fingers (in the period of contracture). |
| 13. The tibilialis anterior phenomenon
(Strümpell): an associated movement of dorsal flexion and
adduction of the foot caused by voluntary flexion of the
affected limb. |
| 14. Associated adduction and abduction
of the paralyzed lower limb (Raimiste) observed in the patient
lying on his back when he makes an energetic effort to adduct
and abduct the sound limb against resistance. |
| 15. Various associated movements which
according to P. Marie and Foix may be divided into the three
following classes: global synkinesis (general contraction of all
muscles of the hemiplegic side on the occurrence of any effort),
imitation synkinesis (involuntary movements of the hemiplegic
sided tending to reproduce the movement carried out voluntarily
by the sound side), and co-ordination synkinesis (voluntary
contraction of certain muscular groups in the paralysed limb
giving rise to involuntary contraction of the functionally
synergic muscles). |
| 16. Neri's sign: flexion of the knee,
accompanying flexion of the trunk on the paralyzed side. |
| 17. The dorsal reflex of
Mendel-Bechterew, or dorso-cuboid reflex: flexion of the toes of
the paralyzed subject produced by percussion of the
latero-dorsal surface of the cuboid, an opposite movement to
that which occurs normally. This interesting phenomenon is
associated with exaggeration of the tendon reflexes. |
| 18. Reflex hyperkinesis (Claude).
Painful stimulation by pricking, pinching, or pressure of the
muscles sometimes causes reflex movements in the paralyzed upper
limb. |
| 19. The reflex of adduction of the foot
(Raïchline, P. Marie and H. Meige) obtained by stimulation of
the skin on the inner border of the foot. |
