User:Tnasci1313/sandbox

Diagnosis There is no diagnostic test for alternating hemiplegia which makes it very difficult to diagnose. Because alternating hemiplegia is extremely rare it is often missed and the patient is often misdiagnosed with another disorder. Proper diagnosis however, is critical for early treatment of the disorder. There are many criteria that can help in the proper diagnosis of alternating hemiplegia. First the symptoms must be observed before the patient is 18 months of age. Second there must be frequent episodes of hemiplegia involving either side of the body. Third other paroxysmal disorders including tonic attacks, dystonia, nystagmus, strabismus, dyspnoea, and other uncontrollable disorders are noticed to occur. Although common the paroxysmal disorders involving the eye, nystagmus and strabismus, may not be apparent in older children and may not have been remembered in childhood so a lack of these symptoms does not rule out alternating hemiplegia. Fourth all symptoms clear up directly after falling asleep and usually come back after waking during an attack. This occurrence is very indicative of alternating hemiplegia and as such those who display this are usually diagnosed with probable alternating hemiplegia. Fifth indication of developmental delay, learning disability, or neurological irregularities is present. These issues may not be obvious in very young patients; however it appears in almost all older patients. The final criteria before a diagnosis of alternating hemiplegia can be made, is that all of these symptoms must not be due to another disorder. If the symptoms can be attributed to another disease or disorder then a definitive diagnosis is difficult to make. Weber's syndrome is one form of alternating hemiplegia that is somewhat easy to diagnose. Although Weber's syndrome is rare a child born with the disorder typically has a port-wine stain on the face around the eye. This port-wine stain, however, does not mean the child has weber's syndrome. If the port-wine stain involves the ophthalmic division of the trigeminal nerve than the likelihood of it being weber's syndrome greatly increases. If a port-wine stain around the eye is found the patient should be screened for intracranial leptomeningeal angiomatosis. Magnetic resonance imaging can be used to determine the presence and severity while computed cranial tomography can be used to determine the effect. MRI is the preferred diagnostic test on children presenting with port-wine stain. Other imaging techniques can be used in addition to further determine the severity of the disorder. The initial diagnosis is made based on the presence of neurologic and ophthalmic disease but the disease progresses differently in each patient so after initial diagnosis the patient should be monitored frequently in order to handle further complications resulting from the syndrome.