THE COLD HEMIPLEGIC ARM

Background and Purpose Vasomotor changes occur in the arm after hemipl egic stroke. Previous studies have provided conflicting results, with most showing an increase in skin temperature of the hemiplegic arm. Ho wever, a number of patients complain of distressing coldness of the he miplegic arm. Methods Eleven patients with symptomatic coldness and 10 patients with hemiplegia but no coldness were recruited. The severity of the symptom of coldness was compared by questionnaire with other c ommon symptoms after stroke. A thermographic camera was used to record the finger skin temperature response to cold stress. Blood flow to bo th hands was also measured simultaneously by means of two plethysmogra phs. In all patients there were no symptoms in the unaffected arm, and this was used as a control. Results The symptom of coldness rated hig hly compared with other symptoms. In the symptomatic group the finger temperature on the hemiplegic side was lower at rest (median differenc e at rest, 0.65 degrees C; P<.0001) and at all times after cold stress . In the asymptomatic group the fingers on the hemiplegic side were co lder at rest and after initial cooling (median temperature difference, 0.2 degrees C) but at no other time. Hand blood flow on the hemiplegi c side was also decreased in the symptomatic group by 35%. This was no t seen in the asymptomatic group. Conclusions Coldness of the hand may be a severe and distressing symptom in some patients after hemiplegia . Symptomatic patients have lower finger skin temperatures at rest and after standard cold stress. These symptomatic patients also had reduc ed blood flow to the hemiplegic hand.