Isolated Leg Monoparesis in a Patient with Atrial Fibrillation and Acute Ischemic Small Vessel Disease

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Sook Vui Chong
Chin Hong Kua
Nan Nitra Than


Monoparesis is most commonly caused by dysfunction of the lower motor neurons (LMNs) which innervates the affected limb. This includes lesion affecting the anterior nuclei, ventral nerve roots, lumbosacral plexus, or peripheral nerve. Nevertheless, it can also be due to upper motor neuron lesion, typically seen in lesions of the spinal cord. In general, many conditions that cause hemiplegia, paraplegia or quadriplegia may begin as monoplegia. We illustrate an elderly patient with hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation, who presented with acute monoparesis and radiological evidence suggestive of recent infarct and small vessel disease.

Acute monoparesis, hypertension, diabetes mellitus, dyslipidemia, recent infarct, atrial fibrillation, small vessel disease.

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How to Cite
Chong, S. V., Kua, C. H., & Than, N. N. (2020). Isolated Leg Monoparesis in a Patient with Atrial Fibrillation and Acute Ischemic Small Vessel Disease. Asian Journal of Case Reports in Medicine and Health, 3(1), 1-8. Retrieved from
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Paciaroni M, Caso V, Milia P, et al. Isolated monoparesis following stroke. Journal of Neurology, Neurosurgery & Psychiatry. 2005;76:805-807.

Maeder-Ingvar M, van Melle G, Bogousslavsky J. Pure monoparesis: A particular stroke subgroup? Arch Neurol. 2005;62(8):1221–1224.

Merchut Weakness.

Raghavan P. Upper limb motor impairment post stroke. P Phys Med Rehabil Clin N Am. 2015;26(4):599-610.

Inbo H, Jung YA, Young SC, Sang SC. Isolated distal leg weakness due to a small cerebral infarction masquerading as a spinal lesion. Journal of Korean Neuro-surgical Society. 2007;41(3):182.

Patrick McCaffrey. Cerebral lobes, cerebral cortex and brodmann's areas, CMSD 620 Neuroanatomy of Speech, Swallowing and Language. The Neuroscience on the Web Series. 1998;Chapter 4.

Son MK, Jin SI, Shin DJ. A case of leg monoparesis with sensory deficit due to cerebral infarction. Korean J Stroke. 2011; 13(1):45-47.

Merck Manual.

Wardlaw JM. What causes lacunar stroke? Journal of Neurology, Neurosurgery & Psychiatry. 2005;76:617-619.

Wardlaw JM. What Is a Lacune? Stroke. 2008;39:2921–2922.

Bo Norrving. Lacunar infarction embolism is the key: Against. Stroke. 2004;35:1779–1780.

Decavel P, Vuillier F, Moulin T. Lenticulostriate infarction front neurol neurosci. 2012;30:115-9.

Clinical differentiation between thrombotic and embolic stroke. Neuroscience Clerkship at UH/VA at Basic Core III Case Western Reserve University School of Medicine.

Arboix A, Alio J. Acute embolic stroke: An update. Expert Review of Cardiovascular Therapy. 2011;9(3):367-379.

Wang Y, Gallardo J, Brorson J. Low yield of extensive workup for embolic sources in lacunar stroke patients. J Stroke Cerebrovasc Dis. 2018;27(6):1575-1581.

Gong L, Liu XY, Fang M. Recent progress on small vessel disease with cognitive impairment. Int J Cli Exp Med. 2015;8(5):7701-7709.

Shao YS, Power MC, Mosley T, Clifford J, et al. Association of atrial fibrillation with white matter disease stroke. 2019;50:989-99.

Lawrence AJ, Brookes RL, Markus HS. Pattern and rate of cognitive decline in cerebral small vessel disease: A prospective study. PLoS One. 2015;10(8): e0135523.
DOI: 10.1371/journal.pone.0135523

Serra L, Fadda, Lucia, Perri, et al. Constructional apraxia as a distinctive cognitive and structural brain feature of pre-senile Alzheimer's disease. Journal of Alzheimer's Disease. 2014;38(2):391- 402.

Kamel H, Okin PM, Mitchell SV, Elkind, Iadecola C. Atrial fibrillation and mechanisms of stroke stroke. 2016;47: 895–900.

Bouasquevisque DS, Benavente OR, Shoamanesh A. Antiplatelet theraptyessel disease. Curr Neurol Neurosci Rep. 2019;19:61.

Johansen H, Rutherford OW, Aamodt AH, Russel D et al. New anticoagulants in combination with antiplatelet agents. The Journal of the Norwegian Medical Association. 2016;18:1543-6.

Louis R. Caplan posterior circulation cerebrovascular syndromes.

Pawlukiewicz A, Long DA, Brit Long. Posterior circulation strokes and dizziness: Pearls and pitfalls. E. M. Docs: Practice; 2017.
Available: pitfalls/

Petersen P, Madsen EB, Brun B, Pedersen F, Boysen G. Silent cerebral infarction in chronic atrial fibrillation (abstract). Stroke. 1987;18 (6):1098-100.

Flaccid Stage Treatment in Stroke.

Van GJ. The Babinski sign. Practical Neurology. 2002;2:42-44.

Bhupendra OK. Should the Babinski sign be part of the routine neurologic examination? Neurology; 2019.

Isaza Jaramillo SP, et al. Accuracy of the babinski sign in the identification of pyramidal tract dysfunction. J Neurol Sci. 2014;343(1-2):66-8.

Loo SF, Justin NK, Chong TT. Differentiating extensor plantar response in pathological and normal population. Ann Indian Acad Neurol. 2018;21(2):144–149.