Hemiplegic atrophy

Abstract

Bilateral quadriceps muscle biopsies were examined in 8 patients with spastic hemiplegia following cerebral vascular accidents. In 1/2 the cases, clinical atrophy of the hemiplegic side was present. No correlation was noted between the presence of atrophy and immobilization or sensory deficit. Histological observations of the wasted muscle were uniform and demonstrated a simple atrophy characterized by decrease in fiber diameter and minimal in-ternalization of subsarcolemmal nuclei. The possible mechanisms of "central" atrophy are reviewed and discussed. The often cited concept of disuse as an important etiologic factor is strongly questioned. Involvement of the parietal lobe as a trophic influence may occur, but it is not specific, since it is apparent that lesions in the corticospinal motor system may have a similar effect. It is concluded that a supra-segmental trophic influence on muscle exists. Interruption of this influence leads to muscular atrophy by mechanisms which are yet to be elucidated.