Hemiplegia Dr. Shamekh M. El- Shamy

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- Heart 2-Distal vessels 3-Rare sources: . *Lung *Bones C)- Haemorrhagic: 1-Intracerebral 2-Subarachnoid 3-Subdural or extradural

The causes of intracranial haemorrhage are: 1-Hypertension: 2-Rupture of an intracranial aneurysm angioma 3- Haemorrhagic blood diseases 4-Trauma to the head:

2-Infective: 3- Neoplastic: 4- Demyelinations: 5- Traumatic: 6- Congenital: 7- Hysterical:

-Acute onset & regressive course (vascular, 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):-

.STAGE OF SPASTTC. PARALYSIS: 1-Paralysis of one sideof the body.

2-Hypertonia (spasticity) of the paralysed muscles of clasp-knife type: 3-Exaggerated deep reflexes

5-Positive Babinski sign: 4-Lost superficial reflexes: 5-Positive Babinski sign: 6-Gait :

According to the site of the lesion 3-Cerebral 2-Brain stem 1-Spinal

1-Spinal Cord At the level of the lesion Pain&Tem Deep sensation Below the level of lesion Touch

2-Brain stem 2-Pontine lesions 1-Mid-brain lesion 3-Medullary lesions M.L.B Weber Benedict Millard-Gubler 3-Medullary lesions

3- Cerebral 1- Cortical 2- Subcorical 3- Capsular

MANAGEMENT OF HEMIPLEGIA 1-GENERAL: . Care of the skin: . Care of respiration: .Care of nutrition and fluid balance: .Care of the urinary bladder: . Care of the bowels:

Symptomatic Treatment 1.Cerebral dehydrating 2.Antiemetics 3.Tranquilizers and sedatives 4.Muscle relaxents 5.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.

Thank you