Hemiplegia

Hemiplegia: Description, Causes and Risk Factors: HemiplegiaHemiplegia is paralysis of one half of the body-which includes arm, leg and often face on the affected side. Many conditions give rise to hemiplegia. Generally, an injury to the right side of the brain will cause a left-sided hemiplegia while an injury to the left side of the brain will cause a right-sided hemiplegia. Stroke: is the commonest cause of hemiplegia. Insufficient blood supply to the brain leads to loss of brain functions. The stroke may be caused by:
    • A clot formed within the blood vessel blocking the blood supply'-> a thrombus.
    • A thrombus breaks away from its site of origin and forms a block elsewhere in the circulation. -> an emboli.
    • A bleed from a blood vessel supplying the brain -> hemorrhage.
  • Head injury.
  • Lesion. Results from upper motor lesion/most commonly pyramidal tract lesion. A unilateral lesion of corticospinal tract, results in hemiplegia on contralateral side. Brain stem lesions: Typically cause ipsilateral cranial nerve palsy and contralateral hemiplegia. This condition being known as crossed hemiplegia.
  • Diabetes.
  • Brain tumor.
  • Infections -> meningitis, encephalitis.
  • Migraine syndrome -> recurrent headaches of severe intensity occasionally accompanied by sensations of numbness and tingling in one half of the body.
  • Inflammation of the blood vessels -> vasculitis.
  • Diseases affecting the nerves -> like multiple sclerosis; acute necrotizing myelitis.
  • Conditions presenting from birth -> cerebral palsy. Lack of blood supply damages nerve cells in the brain. Birth trauma, difficult labor, perinatal strokes in infants within 3 days of birth can all cause cerebral palsy.
  • Hereditary diseases -> leukodystrophies. This is a rare disorder affecting the myelin sheath which covers and protects nerve cells in the brain. The condition usually appears in infancy or childhood.
  • Atherosclerosis of intracerebral vessels.
  • Others causes: blood disorders, polycythemia, sickle cell anemia, antiphospholipid syndrome, hyperhomocystinemia, oral contraceptives, dehydration in extremes of age, slowing of blood stream, subarachnoid hemorrhage, vascular malformation, valvular heart disease, infective endocarditis, thrombosis of great vessels.
Risk Factors: Hypertension.
  • Diabetes mellitus.
  • Ischemic heart disease.
  • Obesity.
  • Hyperlipidemia.
  • Smoking.
  • Use of oral contraceptives.
  • Prior stroke, TIA.
Symptoms: Difficulty in walking.
  • Problems in balance, losses balance when trying to walk.
  • Dysphagia (difficulty in swallowing).
  • Trouble with vision. Blurred vision or weakness of the eyes.
  • Difficulty in articulation.
  • Numbness, tingling or loss of sensations on one half of the body.
  • Loss of control over bladder and bowel movements leading to an inability to hold on to stool or urine.
  • Unable to perform tasks like holding objects, tying laces, dressing oneself, buttoning, etc.
  • Feeling depressed.
  • Heightened emotional sensitivity with inability to handle stressful situations.
  • Memory seems poor. Unable to recall recent or past events concerning people, places and activities.
Complications: Urinary tract infection, pneumonia, bed sores, deep venous thrombosis, septicemia, contractures. Diagnosis: Diagnosis is based on following parameters: Routine blood tests; blood count, Hb, sugar, urea, creatinine.
  • Serum electrolytes.
  • X-ray chest - to detect cardiac disease, lung abscess, empyema.
  • Non invasive carotid tests: Carotid ultrasound techniques, ophthalmodynamometry, oculoplethysmography `Directional supra orbital Doppler-'Trans cranial Doppler'
  • Blood culture.
  • Cardiolipin antibodies, lupus inhibitors if antiphospholipid syndrome is suspected.
  • Spinal tap: To diagnose encephalitis or multiple sclerosis
Imaging: ECG, ECHO, Holter monitor: for evaluation of suspected embolic stroke, TIA. An EEG (electroencephalogram) -> can measure the nerve activity within the brain. CT brain: Merits:
  • Immediately excludes hemorrhage.
  • Can detect cerebral edema.
  • Smallest infarct that can be made out -0.5 -1 cm.
Demerits:
  • Cannot detect most infarcts for at least 24 hrs.
  • Does not detect lesions in cortical surface or brainstem.
MRI: Merits:
  • More sensitive than CT in detecting ischemic stroke; better resolution; Within hours, infarct can be detected including infarcts in posterior fossa, cerebral surface and lacuna infarcts of less than cm.
  • Hemorrhagic infarcts can be made out.
  • Blood flow in many intracranial arteries may be imaged.
  • Sections in all planes possible; can diagnose demyelinating diseases.
Demerits: Expensive, not available all 24hrs; claustrophobia. Positron Emission Tomography (PET scan): Advantage: assesses the function of the neurons. SPECT: Single photon emission computerized tomography. DSA (Digital Subtraction Angiography). Digital subtraction angiography of cerebrum usually performed by retrograde femoral artery catheterization. Four vessel cerebral angiography if indicated in TIA. Treatment: Hemiplegia is often non-progressive and many available measures make coping with it less stressful to the person affected as well as Caregivers. Treatment is often based on cause. General treatment options include: Neuromuscular Electrical Stimulation (NMES). High-intensity electrical stimulation is a proven way to maintain size - and even function - in muscles which must temporarily take a complete break from activity. The right kinds of electrical stimulation can keep muscles relatively sound, even when they are not being stimulated by the nerves or engaging in any real activity.
  • Botulinum toxin injections: Some forms of hemiplegia make the limb muscles very taut and resistant even to passive movements. Botulinum injections decrease the high muscle tone of these muscles. However, it is only a temporary and expensive solution to a chronic condition.
  • Intensive physiotherapy sessions: Activities like standing, walking are done repetitively under the guidance of trainers to prevent muscle degeneration from prolonged under use.
  • Occupational and speech therapy help to cope with physiological changes with clinical psychologist.
Children with hemiplegia may require admission in the intensive care unit (ICU) especially if there are any respiratory infections or breathlessness. Low doses of ibuprofen (pain-killer) will help in minimizing the muscle pains after an acute attack. Sound sleep is known to decrease the severity of the attacks. Hence, one must ensure that the child gets sufficient amount of sleep. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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