Hemiplegia

INTRODUCTION -

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 fifth Cervical segment ( beginning of origin of cervical plexus ) .

ETIOLOGY

VASCULAR - Cerebral hemorrhage , Stroke , Diabetic Neuropathy.

INFECTIVE - Encephalitis , Meningitis , Brain abscess.

NEOPLASTIC - Glioma - meningioma

DEMYLINATION - Disseminated sclerosis , lesions to the Internal capsule .

TRAUMATIC - Cerebral lacerations , Subdural Hematoma . Rare cause of hemiplegia is due to local anaesthsia injections given intra arterially rapidly , instead of given in a nerve branch .

CONGENITAL - Cerebral palsy

DISSEMINATED - Multiple Sclerosis

PSYCHOLOGICAL - Parasomnia (Nocturnal hemiplegia ).

MECHANISM -

Damage to the corticospinal tract leads to the injury on the opposite side of the body. This happens because the motor fibres of the corticospinal tract , which take origin from the motor cortex in brain , cross to the opposite side in the lower part of medulla oblongata and then descend down in spinal cord to supply their respective muscles.

Depending on the site of lesion in brain , the severity of hemiplegia varies.

• INTERNAL CAPSULE -

Dense and uniform Hemiplegia ( UMN Facial )

Hemisensory blunting

Homonymous hemianopia

• CORTEX -

Non dense non uniform weakness

Monoplegia

Cortical signs ( Dysphasia , Apraxia , Cortical sensory loss , Convulsions )

• SUBCORTEX -

Pattern of weakness similar to cortical

• BRAINSTEM -

Crossed hemiplegia

Ipsilateral LMN CN Palsy and contralateral hemiplegia

Cerebellar signs.

• MIDBRAIN -

Crossed cerebellar ataxia with Ipsilateral Third nerve palsy ( Claude `s syndrome )

Weber`s syndrome - Third nerve palsy and contralateral hemiplegia

Contralateral hemiplegia - Cerebral peduncle

Contralateral rhythmic , ataxic action tremor ; rhythmic postural or holding tremor (rubral tremor)

• PONS -

LMN Facial and contralateral hemiplegia

Fifth nerve and contralateral hemiplegia

Lateral Gaze palsy and contralateral hemiplegia

• MEDULLA - Lateral medullary syndrome

Same side ( Horner `s syndrome , Loss of pain and touch on the face , Cerebellar signs , Palate weakness )

Opposite side ( Loss of pain and temperature sensation on the body and limbs )

• MEDULLA - Medial medullary syndrome

Same side ( wasting and weakness of the tongue )

Opposite side ( hemiplegia without facial palsy )

• SPINAL CORD -

Rare

No facial

Brown sequard Syndrome

MEDICAL DIAGNOSIS

HISTORY AND EXAMINATION

An accurate history profiling the timing of neurological events is obtained from the patient or from family members in the case of the unconscious or noncommunicative patient . Of particular importance are the exact time and pattern of symptom occurs . The most common , slowest in hours , wakes up in the morning with weakness , history of TIA , old age is typical with thrombosis . An embolus occurs rapidly with no warning , history of heart disease , younger age group , no progression (maximum deficit occurs at onset) . An abrupt onset with worsening symptoms , history of prolonged hypertension , severe headache described as "worst headache of my life " , altered consciousness , convulsions , vomiting is suggestive of haemorrhage. The patient 's past history , including episodes of TIAs or head trauma , presence of major or minor risk factors and medications , pertinent family history and recent alterations in patient function ( either transient or permanent ) are thoroughly investigated.

The physical examination of the patient includes an investigation of vital signs ( heart rate , respiratory rate , blood pressure , clubbing ) , signs of cardiac decompensation, and function of the cerebral hemispheres , cerebellum , cranial nerves , eyes and sensorimotor system.

OUTCOME MEASURES

NIH Stroke Scale

Dynamic Gait Index, the 4-item Dynamic Gait Index, and the Functional Gait Assessment show sufficient validity, responsiveness, and reliability for assessment of walking function in patients with stroke undergoing rehabilitation, but the Functional Gait Assessment is recommended for its psychometric properties^[7].

Chedoke-McMaster Stroke Assessment

Chedoke Arm and Hand Activity Inventory

CRS-R Coma Recovery Scale Revised is used to assess patients with a disorder of consciousness, commonly coma.

Take a look at our Stroke Outcome Measures Overview for more information