Infantile hemiplegia: Description, Causes and Risk Factors:
Infantile hemiplegia. Acute hemiparesis that occurs in infancy and is usually caused by a vascular accident such as cerebral infarction or thrombosis; frequently associated with seizures.
Infantile hemiplegia is a rare condition of the nervous system that usually appears in children prior to the age of 4. The unborn child can develop hemiplegia through various developmental complications, or infections contracted by the mother during the child's development could also bring on the condition. It is sometimes referred to as alternating hemiplegia because it can affect alternating sides of the body. A person suffering from infantile hemiplegia experiences temporary bouts with paralysis on one side of the body. The episodes can vary in length, and they can also vary in frequency throughout the life of the afflicted child.
Many of the causes of infantile hemiplegia are developmental and can appear while the child is still in the womb. It is possible for an unborn child to contract the brain infection known as meningitis, which can be a catalyst for the onset of infantile hemiplegia. Children who develop multiple sclerosis early in their development could also run the risk of developing hemiplegia, as well as children with certain types of infant diabetes.
In some cases, the blood vessels and arteries in the brain can develop improperly in an unborn child during pregnancy
as part of a developmental condition called arteriovenous malformations. These defective blood vessels can deny the brain the blood it needs during development and during the first few years of life, and this can lead to infantile hemiplegia.
The triggers can vary, but they usually relate to exposure to low temperatures, emotional stress or even the stress created by bathing. While it is possible to limit the attacks a child experiences by reducing his exposure to these potential outside elements, this can also provide a major inconvenience for the daily life of the family.
: The present study retrospectively examines these clinicopathologic features in a surgical series of 21 patients with infantile hemiparesis. The study group was comprised of 21 patients, 13 females and 8 males, ranging in age from 5 to 41 years (mean, 20 years) at the time of surgery. Hemiparesis involved the right side in 16 patients and the left side in 5 patients. Imaging studies identified porencephaly in 8 patients (38%), encephalomalacia in 5 patients (24%), focal cerebral atrophy in 9 patients (43%), ventricular dilatation in 6 patients (29%), and white matter hyperintensities in 4 patients (19%). Concomitant neurologic diseases included medically intractable epilepsy in all 21 patients and visual field defects in 11 patients (52%). Significant perinatal history included prematurity in 7 patients (33%) and cesarean section, forceps delivery, placental abruption, fetal distress, and prolonged rupture of membranes each in 1 patient (5%). The remainder of the patients had an uncomplicated perinatal course (43%). Twelve patients underwent functional hemispherectomy (57%), 8 patients underwent lobectomy (38%) and 1 patient underwent "cyst" resection (5%). Histological evaluation demonstrated lesional (corresponding to radiographic findings) tissue in 15 of the 21 cases (71%). Infarction, malformations due to abnormalities of cortical development (cortical dysplasia) and gliosis with microcalcifications were each found in 6 patients (29%). Infarction and a geographically distinct area of cortical dysplasia were found to coexist in 1 case. Histopathologic findings in the 6 cases in which excised tissue was considered nonlesional included gliosis in all 6 of the cases, hippocampal sclerosis in 2 cases (10%), and neuronal heterotopia in 2 cases (10%). An osteoma was identified in 1 patient. The most common pathological findings observed in our series were infarction and cortical dysplasia, although radiographically, infarct-related changes were the most evident. Hippocampal sclerosis was encountered in 2 patients, suggesting that a subset of cortical dysplasias and hippocampal sclerosis may be caused by an in utero ischemic event.
The onset is not infrequently attended by general malaise and slight fever, the temperature rarely exceeding 102°. This is followed in twenty-four or forty-eight hours by convulsions, generally on the side which is afterwards paralyzed
. The convulsions may occur at slight intervals, the patient losing consciousness.
Many times the disease comes on suddenly without a single premonitory symptom, the patient suddenly becoming unconscious and on the return to consciousness it is found that the child is paralyzed, the right side being the most frequently involved and the arm more seriously than the leg. Atrophy of the muscles, especially of the arm, is quite marked.
Epilepsy is a frequent result, especially when the hemiplegia is from birth.The knee-jerk and ankle clonus may be present.Posthemiplegic movements consist of tremors, choreiform movements, and athetosis.
Infantile hemiplegic have additional medical problems such as speech difficulties, visual field defects or epilepsy. Many others have less obvious additional difficulties, such as perceptual problems, specific learning difficulties, or emotional and behavioral problems, which may be more frustrating and disabling than their physical problems.
There is no medical test that confirms the diagnosis of infantile hemiplegia. The diagnosis is made on the basis of various types of information gathered by the child's health care provider and, in some cases, other consultants.
Lab studies: Various blood and urine tests may be ordered if your child's health care provider suspects that the child's difficulties are due to chemical, hormonal, or metabolic problems. Analysis of the child's chromosomes, including karyotype analysis and specific DNA testing, may be needed to rule out a genetic syndrome.
Ultrasound of the Brain: Ultrasound uses harmless sound waves to detect certain types of structural and anatomic abnormalities. For instance, it can show hemorrhage (bleeding) in the brain or damage caused by lack of oxygen to the brain. Ultrasound is often used on newborns who cannot tolerate more rigorous tests such as CT scans or MRI.
CT scan of the brain: This scan is similar to an x-ray but shows greater detail and gives a more 3-dimensional image. It identifies malformations, hemorrhage, and certain other abnormalities in infants more clearly than ultrasound.
MRI of the brain: This is the preferred test, since it defines brain structures and abnormalities more clearly than any other method. Children who are unable to remain still for at least 45 minutes may require a sedative to undergo this test.
MRI of the spinal cord: This may be necessary in children with spasticity of the legs and worsening of bowel and bladder function, which suggest an abnormality of the spinal cord. Such abnormalities may or may not be related to cerebral palsy.
Electroencephalography (EEG): EEG is important in the diagnosis of seizure disorders. A high index of suspicion is needed in order to detect non-convulsive or minimally convulsive seizures. This is a potentially treatable cause of a CP-look-alike, which is easier to treat when treated early.
Electromyography (EMG) and nerve conduction studies (NCS) may be helpful in distinguishing CP from other muscle or nerve disorders.
Exercise, stretching, splinting, heat, electric stimulation and other modalities have the potential to improve a infantile hemiplegia, usually of a brain origin. Prognosis after a spinal cord lesion may be actually better although much rarer. Of the brain causes, recovery is influenced by many factors including age, other health problems and amount of brain damaged. Sometimes no improvement will occur.
There are special walkers, wheelchairs, shower chairs, devices that help with dressing, grooming and bathing and eating. There are devices that help move paralyzed limbs. There are modified vehicles that allow persons with a stroke to drive if possible.
A nutritious and easily digested diet, plenty of fresh air and sunshine, massage and faradization, and systematic education, will be important factors in the treatment.
NOTE: The above information is for processing 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.