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Quadriceps muscle weakness following acute hemiplegic stroke

M I Polkey

Department of Respiratory Medicine and Allergy, London, UK

P MW Bath

Acute Stroke Unit, London, UK

J Moxham

Department of Respiratory Medicine and Allergy, Guy’s, King’s & St Thomas’ School of Medicine, King’s College Hospital, London, UK

Objective: To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute ischaemic hemiplegic stroke.

Design: A prospective study of muscle strength.

Setting: Acute stroke unit (ASU) in a teaching hospital.

Subjects: Ten patients admitted within 48 hours of stroke onset, and 10 healthy age-matched controls.

Interventions: Repeat nonvolitional measurements of quadriceps muscle strength of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apart. In addition the level of voluntary activation was assessed during a maximum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients.

Results: The median (95% confidence interval, (CI)) baseline quadriceps twitch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1–12.5 kg) and 37.2 kg (23.8–54.6 kg), and in the stroke group were 7.6 kg (4.4–9.9 kg) and 12.15 kg (7.9–30.8 kg). The median (95% CI) change in Tw Q and MVC respectively between baseline and one week later were 1.75% (–9.8 to 8%) and 5.45% (–15.1 to 22.7%) (NS) in the control group and –16.2% (–6 to –25.9%) and –30.45% (0 to –78.6%) (p < 0.01) in the stroke patients. There was a significant correlation between the percentage fall in Tw Q and both change in TCT (r_s = 0.83, p < 0.01) and percentage change in body weight (r_s = 0.83, p < 0.01).

Conclusion: In the first week after acute hemiplegic stroke, weakness develops in the unaffected leg.

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