Quadriceps muscle weakness following acute hemiplegic stroke

Objective: To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute isch aemic 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 hea lthy age-matched controls. Interventions: Repeat nonvolitional measurements of quadriceps muscle stren gth of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apar t. In addition the level of voluntary activation was assessed during a maxi mum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients. Results: The median (95% confidence interval, (CI)) baseline quadriceps twi tch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1-12.5 kg) a nd 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 res pectively 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%) a nd -30.45% (0 to -78.6%) (p < 0.01) in the stroke patients. There was a sig nificant 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 devel ops in the unaffected leg.