A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs

Abstract

Objective : To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Method : Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. Results : From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. Conclusion : The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS.

Crossed Leg Sign Is Associated With Severity of Unilateral Spatial Neglect After Stroke

“…Several textbooks on semiology and neurological examination do not describe the crossed leg sign as a clinical sign in the acute phase of stroke ( 14 – 16 ). In recent years, however, patients with acute stroke in the right hemisphere and changes in consciousness have been reported to present with this behavior during hospitalization, and this appears to be especially true in patients with USN and misinterpretation of the midline ( 7 ).…”

“…The crossed leg sign was first described in patients with right hemisphere stroke who presented with USN, including cases in which there were associated changes in consciousness ( 7 ). It is impossible to detect USN during coma, but frequent rubbing movements of the right leg over the left observed in the first days of clinical evolution may differentiate between patients with torpor and coma.…”

“…This sign is characterized by an overlap of the right leg over the left as the patient attempts to orient to the midline because there is a loss of spatial orientation of the left space. If the left leg is not perceived or felt to be one’s own limb, then abnormal rubbing movements may appear, which may be of predictive value in the development of USN ( 7 ).…”

Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…5,6 A tendency to explore and accentuate orientation to the ipsilesional side of the patients and nonrecognition of items on the contralesional side is provoked by USN. 2,[7][8][9][10][11][12][13][14] Main treatments for patients with USN after stroke are the "top-down" approaches, 15 which aim to implant voluntary attention, and "bottom-up" techniques, which aim to automatically capture attention to stimuli or events in the environment. [16][17][18][19][20][21][22] There is evidence of the effectiveness of several "bottom-up" approaches to improve USN performance, among which limb activation has been highlighted as a technique to reduce visuospatial deficits in patients with USN after stroke.…”