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History Taking Format for Hemiparesis
1. Patient Details
Name, Age, Sex, Occupation, Handedness, Address
2. Presenting Complaint
Weakness or heaviness of one side of the body (specify right/left, upper/lower limb, face)
Duration of symptoms
3. History of Presenting Illness
Onset: Sudden or gradual? Exact time and circumstances of onset (awake, asleep, during activity)?
Progression: Was the weakness maximal at onset or did it worsen over time? (sudden and non-progressive suggests embolic, gradual progression suggests thrombotic, rapid progression with headache suggests hemorrhagic)
Distribution: Which parts are affected—face, arm, leg? Is it proximal, distal, or both? (Ask about specific activities: combing hair, buttoning shirt, walking, etc.)3
Associated symptoms:
Sensory loss (numbness, tingling)
Speech or language difficulties (aphasia, dysarthria)
Facial deviation, drooling, swallowing difficulty
Visual disturbances (loss of vision, double vision)
Headache (sudden, severe—consider hemorrhage)
Loss of consciousness, seizures
Incontinence
Risk factors and relevant history:
Hypertension, diabetes, heart disease, atrial fibrillation, previous stroke/TIA, smoking, alcohol use, recent trauma or infection
Previous episodes: Any similar attacks before? Residual deficits?
Effect on daily activities: Ambulation, self-care, feeding, speech
4. Past Medical History
Previous stroke/TIA, hypertension, diabetes, heart disease, dyslipidemia, migraine, epilepsy, trauma, infections, malignancy57
5. Drug History
Current and recent medications (antiplatelets, anticoagulants, antihypertensives, statins, OCPs, HRT)
Any recent changes or missed doses
Allergies and adverse drug reactions
6. Family History
Stroke, TIA, hypertension, diabetes, heart disease, clotting disorders in family members (ask about age of onset and cause of death if relevant)6
7. Personal and Social History
Smoking, alcohol, illicit drug use
Diet, physical activity, occupation, living situation
Support system and access to care
8. Socioeconomic History
Occupation, education, financial status, access to healthcare
9. Systemic Enquiry
Cardiovascular: Chest pain, palpitations, breathlessness
Respiratory: Cough, dyspnea
Genitourinary: Incontinence
Gastrointestinal: Dysphagia, vomiting
General: Fever, weight loss, fatigue
Case History
Personal Details:
Mr. Arjun Mehta, 58-year-old male, retired teacher
Presenting Complaint:
Sudden-onset left-sided weakness for 12 hours
History of Presenting Illness:
Mr. Mehta was apparently well until 12 hours ago, when he awoke in the morning and noticed sudden weakness of his left arm and leg. He found it difficult to grip objects with his left hand and was unable to stand or walk without assistance due to weakness in his left leg. He also noticed mild slurring of speech at the same time but did not have any facial deviation, drooling, or difficulty swallowing.
The weakness was maximal at onset and has remained stable since then, with no improvement or worsening. There was no preceding headache, visual disturbance, dizziness, loss of consciousness, or seizure activity. He did not experience any sensory symptoms such as numbness or tingling on the affected side.
He denies any recent trauma, neck pain, fever, or symptoms of infection. There is no history of similar episodes in the past, nor any transient episodes of weakness or speech difficulty (no prior TIA).
He has not experienced chest pain, palpitations, or breathlessness around the time of symptom onset. There is no history of incontinence of urine or stool. He has not noticed any recent weight loss, night sweats, or signs of malignancy.
The event occurred at home, not during exertion or emotional stress. Family members did not witness any convulsive movements or tongue biting. He was brought to the hospital promptly for evaluation.
Past Medical History:
Hypertension (15 years, poorly controlled)
Type 2 diabetes mellitus (10 years)
No previous strokes, TIA, or heart disease
Drug History:
Irregular use of amlodipine 5 mg
Metformin 500 mg twice daily
No anticoagulants or antiplatelets
Family History:
Father died of myocardial infarction at 65
Mother has diabetes
Personal/Social History:
Sedentary lifestyle
Diet: High in carbohydrates and fats
Ex-smoker (quit 2 years ago)
No alcohol use
Socioeconomic History:
Lives with spouse in an urban area
Middle socioeconomic status
Access to local healthcare
Systemic Enquiry:
No cough, chest pain, or palpitations
No dysphagia or urinary symptoms
Case Summary
A 58-year-old hypertensive, diabetic male with a history of smoking presents with sudden-onset, persistent left-sided hemiparesis and mild dysarthria, without sensory loss, headache, seizure, or preceding trauma. There are no constitutional or systemic symptoms.
Differential Diagnosis
Ischemic Stroke
Hemorrhagic Stroke
Considered, but less likely without headache, vomiting, or altered consciousness8.
Transient Ischemic Attack (TIA)
Less likely, as symptoms have persisted beyond 24 hours4.
Spontaneous Spinal Epidural Hematoma
Rare, but should be considered if there were neck pain or rapid progression to quadriparesis6.
Cerebral Neoplasm (with acute event, e.g., hemorrhage into tumor)
Possible but less likely given the sudden onset and lack of preceding symptoms8.
Metabolic Causes (e.g., hypoglycemia, electrolyte disturbance)
Unlikely, as there are no fluctuating symptoms or altered mental status.
Infective or Inflammatory CNS Disease (e.g., abscess, encephalitis, meningovascular syphilis)
Viva Questions and Answers on Hemiparesis
1. What is the difference between hemiparesis and hemiplegia?
Hemiparesis is weakness on one side of the body, while hemiplegia is complete paralysis of one side of the body58.
2. What are the common causes of hemiparesis in adults?
Ischemic stroke (most common)
Intracerebral hemorrhage
Brain tumor
Head trauma
CNS infections (e.g., abscess, encephalitis)
3. How do you differentiate between upper motor neuron (UMN) and lower motor neuron (LMN) lesions in hemiparesis?
UMN lesions present with spasticity, increased deep tendon reflexes, and an extensor plantar response (Babinski sign), while LMN lesions show flaccidity, muscle atrophy, fasciculations, and decreased reflexes5.
4. What is the significance of sudden-onset hemiparesis?
Sudden-onset hemiparesis is most commonly due to a vascular event, such as ischemic or hemorrhagic stroke. It is a medical emergency and requires urgent evaluation and management57.
5. What associated symptoms would you ask about in a patient with hemiparesis?
Speech disturbances (aphasia, dysarthria)
Sensory loss
Visual disturbances
Headache
Altered consciousness or seizures
6. What are the risk factors for stroke-related hemiparesis?
Hypertension
Diabetes mellitus
Smoking
Dyslipidemia
Atrial fibrillation
Previous stroke or TIA
Family history of cardiovascular disease5.
7. What is receptive (Wernicke’s) aphasia and is it associated with hemiparesis?
Receptive aphasia is difficulty understanding spoken or written language, usually due to a lesion in Wernicke’s area. It is typically not associated with hemiparesis, as motor pathways are not involved6.
8. What is the difference between plegia, paresis, monoplegia, diplegia, and quadriplegia?
Plegia: Complete paralysis
Paresis: Weakness
Monoplegia: Paralysis of one limb
Diplegia: Paralysis of similar parts on both sides (often legs)
Quadriplegia: Paralysis of all four limbs5.
9. What investigations would you order in a case of acute hemiparesis?
Neuroimaging (CT/MRI brain)
Blood glucose
Electrolytes
ECG (for arrhythmias)
Complete blood count
Coagulation profile
Echocardiography if cardioembolic source is suspected5.
10. What are the principles of acute management in a patient with sudden-onset hemiparesis?
Rapid assessment and stabilization
Immediate neuroimaging to differentiate ischemic from hemorrhagic stroke
Control of blood pressure, blood glucose, and oxygenation
Thrombolysis if indicated and within window period for ischemic stroke
Supportive care and prevention of complications5.