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A Particular Stroke Subgroup?

Malin Maeder-Ingvar, MD; Gus van Melle, PhD; Julien Bogousslavsky, MD

Arch Neurol. 2005;62:1221-1224.

Background  Acute stroke presenting as monoparesis is rare, with a pure motor deficit in the arm or leg extending to an isolated facial paresis.

Objective  To raise the question if acute stroke presenting as monoparesis is a different entity from stroke with a more extensive motor deficit.

Patients  In the Lausanne Stroke Registry (1979-2000), 195 (4.1%) of 4802 patients met the clinical criteria for pure monoparesis involving the face (22%), arm (63%), or leg (15%).

Results  In the vast majority of cases (>95%), monoparesis corresponded to ischemic stroke with a favorable outcome, with initial computed tomography scans or magnetic resonance images showing no signs of hemorrhage. The lesion for a facial deficit was most frequently located subcortically (internal capsule); for an arm deficit, in the superficial middle cerebral artery; and for a leg deficit, in the anterior cerebral artery territory. In pure monoparesis, only 17% of the patients had more than 1 risk factor as compared with 26% of those with bimodal and trimodal hemiparesis and with 46% of all patients with stroke other than those with pure motor stroke. The only frequent risk factor was hypertension (53%); however, this frequency was no different from that in other patients with stroke. No major stroke etiology could be identified in any of the 3 subgroups of monoparesis.

Conclusion  Our finding of a wide range of stroke localization and etiology in monoparesis without any particular subgroup suggests that no specific plan of investigation can be recommended for these patients.

Author Affiliations: Department of Neurology, University Hospital of Vaud (Drs Maeder-Ingvar and Bogousslavsky), Institute of Social and Preventive Medicine (Dr van Melle), University of Lausanne, Lausanne, Switzerland.

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