CLINICAL FEATURES OF HEMIPLEGIA

HEMIPLEGIA

• Weakness of one half of body with or without involvement of face

• PRESENTATION OF UNILATERAL LESION ABV C5 LEVEL OF SPINAL CORD

•How was the onset and how did it progress???

ONSET AND PROGRESS

• THROMBOTIC

• EMBOLIC

• HEMORRHAGIC

THROMBOTIC STROKE

• Onset during sleep or on rising• Usually in elderly• Stepwise evolution• Preservation of consiousness• Gradual recovery

• No seizure or headache

• h/o prodromal TIA’s

• Evidence of atheroscelerosis

EMBOLIC• Abrupt development of completed

stroke within few seconds • Rapid improvement within minutes or

hours• Occur at any time• Relative preservation of consiousness• Occur in any age

• Localised headache,seizures +• Rapid recovery• Evidence of recent stroke• No history of prodromal TIA

HEMORRHAGIC• Presence of hypertension• Onset during walking hours• Headache +/_ , seizure+ , vomiting +• Deepening stupor/ coma• Gradual development

• Nuchal rigidity• Delayed or no recovery• Absence of prodromal symptoms

•LOCALIZATION ????

PYRAMIDAL TRACTUMN• Weakness in the

corticospinal dist

• Distal muscle groups• Axial movts are spared

• Extraocular,upper facial,pharyngeal,jaw muscles are spared

LMN• Weakness in the spinal

segment dist

• Wasting

• Hypertonia• Exaggrated tendon

reflex• No muscle wasting• Extensor plantar

response• Loss of abdominal

reflexes

• Hypotonia• Loss of tendon reflex• Muscle wasting• Fasciculation &

contracture of affected muscle

• Trophic changes in skin nail

What the patient complaints off ????

• Stiffness of legs• Unable to walk on rough ground• Diff.to climb stairs• Vibration of limb while stepping down

the stairs- ankle conus• Finally,dragging of foot,stiff legged

gait,keeps tripping over,shoes wearing off

Features of extrapyramidal

lesion• Difficulty to initiate voluntary movt• Hypertonia-rigidity• No loss of power of muscles• Bradykinesia• Inv movts• Postural instability

Associated features

• Headache and vomiting• Altered level of consiousness• Seizure• Speech abnormality• Altered behaviour• Bowel and bladder involvement

Cerebellar symptoms

• Wide based gait• Scanning speech• Nystagmus,tendency to fall• Weakness due to hypotonia(pendular

knee jerk)• Dysdiadocokinesis• Dysmetria• Intention tremor

POSTERIOR TRACT INV

• Diff.to stand ,walk• Positive rombergs sign• Stamping gait• Unable to walk in dark

cranial nerve involvement