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November 1989

Herald Hemiparesis

Author Affiliations

Department of Neurology University of Maryland Hospital 22 S Greene St Baltimore, MD 21201

Arch Neurol. 1989;46(11):1164. doi:10.1001/archneur.1989.00520470014003

To the Editor.  —Dr Fisher's article "Herald Hemiparesis" added a few new cases to the literature about a phenomenon already recognized and reported several times. Dr Fisher cites only one reference that is not about this problem. In 1983, Liu and coworkers1 described three patients (two who underwent autopsy) that presented with dysarthria and unilateral sensory or motor deficit, and then evolved or progressed. The point of their article was to call attention to the misleading early presentation due to basilar artery disease and the later progression of deficit. They cited four previous reports of cases with such a deficit and progression to a locked-in state. An additional abstract in 19842 reported the frequency of initial unilateral hemiparesis (15 of 59 brainstem infarctions, of which 10 progressed).Reports of observations of patients are the foundation of clinical knowledge. I have always thought that a requirement for their success is

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