Hemiplegia

Dr. Shamekh M. El- Shamy

Hemiplegia

Definition: paralysis of one side of the body due to pyramidal tract lesion at any point from its origin in the cerebral cortex down to the 5th cervical segment.

Causes-:

1-Vascular causes-:

A)-Thrombotic-:

1-Vessels wall diseases.

2-Blood diseases.

3-Circulation diseases.

B) - Embolic : The source of embolus may be:-

1- Heart2-Distal vessels3-Rare sources: . *Lung

*Bones

C)- Haemorrhagic:1-Intracerebral2-Subarachnoid3-Subdural or extradural

The causes of intracranial haemorrhage are:

•1-Hypertension:

2-Rupture of an intracranial aneurysm angioma

3 -Haemorrhagic blood diseases

4-Trauma to the head:

2-Infective: 3- Neoplastic: 4- Demyelinations: 5- Traumatic: 6- Congenital: 7- Hysterical:

CLINICAL PICTURE 

Onset & Course:•-Acute onset & regressive course (vascular ,

infective & traumatic lesions.)

•-Gradual onset & progressive course (neoplastic lesions).

•-Remittent & relapsing course (D.S.).

Symptoms & Signs

1-Acute lesions: the clinical picture passes through 2 stages:

•A)-Stage of flaccidity: due to neuronal shock.

•B)-Stage of spasticity: this is the stage of established hemiplegia.

•2-Gradual lesions: the hemiplegia passes directly to the stage of spasticity.

–STAGE OF FLACCID PARALYSIS (SHOCK STAGE):-

•2-Hypertonia (spasticity) of the paralysed muscles of clasp-knife type:

3-Exaggerated deep reflexes

4-Lost superficial reflexes:

5-Positive Babinski sign:

6-Gait :

According to the site of the lesion

1-Spinal

3-Cerebral

2-Brain stem

1-Spinal CordAt the level of the lesion

Below the level of lesion

Deep sensationPain&Tem

Touch

2-Brain stem1-Mid-brain lesion

WeberBenedict

M.L.B

Millard-Gubler

2-Pontine lesions

3-Medullary lesions

3- Cerebral

1- Cortical2- Subcorical3- Capsular

MANAGEMENT OF HEMIPLEGIA

1-GENERAL:. Care of the skin:. Care of respiration:.Care of nutrition and fluid balance:.Care of the urinary bladder:. Care of the bowels:

Symptomatic Treatment

1.Cerebral dehydrating

2.Antiemetics

3.Tranquilizers and sedatives

4.Muscle relaxents5.Vitamins and tonics .

3- Physiotherapy

1- Proper positioning of the hemipegic side.2-Passive,active assited,active exercises. . To minimize contractures . To strength muscles

3-Antispastic methods to control spasticity.4-Gait and balance training.

4- Specific Treatment

1)- Cerebral Thrombosis:A-Care of Blood Pressure * Hypotensive drugs---------if B.P is above 200/120. Capotril--------25to50 t.d.s* Vasopressor drugs-----------if B.P is very low.B- Anti platelates: *Aspirin: single dose 75-300mg daily*Persantin:75 mg twice daily* Ticlopidine:250 mg twice daily

C- Anticoagulants: used in all cases Indications:

Contraindications:

• Method : * Heparin

* Dindivan or Marcoumar: anticoagulants. - Monitor the dose using the prothrombin time.

* Antidote :-

D- Other drugs may be used:

1- Nootropil :

2- Trental :

3- Trivastal :

4- Cerebral Vasodilators :

B-Cerebral Embolism :

c- Cerebral Haemorrhage :

D- Cerebral Inflammation:

E- Brain Tumors : 1- Surgical removal. 2- Deep X-rays therapy.

Thank you