Bell's Cruciate Paralysis and Hemiplegia Cruciata

The condition named 'cruciate paralysis' by Bell (*) is an infrequent neurological finding. The lesion is situated at the cervicomedullary junction, proximal to the pyramidal decussation. The corticospinal tract of the upper extremity descends more medially and anteriorly relative to that of the lower extremity. Also, the decussation of the upper extremity fibers is located proximal to the level of the foramen magnum, which is approximately one cord segment proximal to that of the lower extremity. This anatomic and topographic difference sometimes causes unusual clinical manifestations such as cruciate paralysis and hemiplegia cruciata.
Characteristically, patients with cruciate paralysis present with bilateral paresis of the upper extremities without significant involvement of the lower extremities. This condition may be caused by mechanical injury, metabolic disorders, or complications of surgery of that area. When the neural compromise occurs predominantly on one side, spastic palsy on the ipsilateral side of the upper extremity is present, which is associated with spasticity on the contralateral side of the lower extremity, described as hemiplegia cruciata.

(*) Bell HS. Paralysis of both arms from injury of the upper portion of the pyramidal decussation: 'cruciate paralysis'. J Neurosurg 1970; 33: 376–380.

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