1. Hemiplegia
Dr. Shamekh M. El- Shamy

2. 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.

3. Causes:- 1-Vascular causes:- A)-Thrombotic:- 1-Vessels wall diseases.
2-Blood diseases.
3-Circulation diseases.

4. 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

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

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

7. -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.).

8. 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.

9. STAGE OF FLACCID PARALYSIS (SHOCK STAGE):-

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

11. 2-Hypertonia (spasticity) of the paralysed muscles of clasp-knife type:
3-Exaggerated deep reflexes

12. 5-Positive Babinski sign:
4-Lost superficial reflexes:
5-Positive Babinski sign:
6-Gait :

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

14. 1-Spinal Cord At the level of the lesion Pain&Tem Deep sensation
Below the level of lesion
Touch

15. 2-Brain stem 2-Pontine lesions 1-Mid-brain lesion 3-Medullary lesions
M.L.B
Weber
Benedict
Millard-Gubler
3-Medullary lesions

16. 3- Cerebral
1- Cortical 2- Subcorical 3- Capsular

17. 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:

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

19. 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.

20. 4- Specific Treatment 1)- Cerebral Thrombosis:
A-Care of Blood Pressure
* Hypotensive drugs if B.P is above 200/120.
Capotril to50 t.d.s
* Vasopressor drugs if B.P is very low.
B- Anti platelates:
*Aspirin: single dose mg daily
*Persantin:75 mg twice daily
* Ticlopidine:250 mg twice daily

21. C- Anticoagulants: used in all cases
Indications:
Contraindications:

22. Method : * Heparin * Dindivan or Marcoumar: anticoagulants.
- Monitor the dose using the prothrombin time.
* Antidote :-

23. D- Other drugs may be used:
1- Nootropil :
2- Trental :
3- Trivastal :
4- Cerebral Vasodilators :

24. B-Cerebral Embolism : c- Cerebral Haemorrhage : D- Cerebral Inflammation:

25. E- Brain Tumors :
1- Surgical removal.
2- Deep X-rays therapy.

26. Thank you