Hemiplegia
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 -Hemorrhagic 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 HEMIPLEGIA1-GENERAL:. Care of the skin:. Care of respiration:.Care of nutrition and fluid balance:.Care of the urinary bladder:. Care of the bowels:
Symptomatic Treatment1.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.
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