Hemiplegia

From Wikipedia, the free encyclopedia

Hemiplegia is a condition in which the limbs on one side of the body have severe weakness.
Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked
weakness.[1] Hemiplegia may be congenital or acquired from an illness or stroke.

Hemiplegia is not an uncommon medical disorder. In elderly individuals, strokes are the most
common cause of hemiplegia. In children, the majority of cases of hemiplegia have no
identifiable cause and occur with a frequency of about one in every thousand births. Experts
indicate that the majority of cases of hemiplegia that occur up to the age of two should be
considered to be cerebral palsy until proven otherwise.[2]

Causes
The most common cause of hemiplegia is a cerebrovascular accident, also known as a stroke.
Strokes can cause a variety of movement disorders, depending on the location and severity of the
lesion. Hemiplegia is common when the stroke affects the corticospinal tract. Other causes of
hemiplegia include spinal cord injury, specifically Brown-Séquard syndrome, traumatic brain
injury, or disease affecting the brain. As a lesion that results in hemiplegia occurs in the brain or
spinal cord, hemiplegic muscles display features of the Upper Motor Neuron Syndrome. Features
other than weakness include decreased movement control, clonus (a series of involuntary rapid
muscle contractions), spasticity, exaggerated deep tendon reflexes and decreased endurance.

It is well known that the incidence of hemiplegia is a lot higher in premature babies than term
babies. There is also a high incidence of hemiplegia during pregnancy and experts believe that
this may be related to either a traumatic delivery, use of forceps or some event which causes
brain injury.[3]

Hemiplegia in adults include trauma, bleeding, brain infections and cancers. Individuals who
have uncontrolled diabetes, hypertension or those who smoke have a higher chance of
developing a stroke. Weakness on one side of the face may occur and may be due to a viral
infection, stroke or a cancer.[4]

Medial medullary syndrome

Main article: medial medullary syndrome

[edit] Common causes by etiology

• Vascular: cerebral hemorrhage,[5] stroke, diabetic neuropathy

• Infective: encephalitis, meningitis, brain abscess
• Neoplastic: glioma-meningioma
• Demyelination: disseminated sclerosis, lesions to the internal capsule
 • Traumatic: cerebral lacerations, subdural hematoma rare cause of
hemiplegia is due to local anaesthetic injections given intra-arterially rapidly,
instead of given in a nerve branch.
• Congenital: cerebral palsy
• Disseminated: multiple sclerosis
• Psychological: parasomnia (nocturnal hemiplegia)[6]

[edit] Pathogenesis
The exact cause of hemiplegia is not known in all cases, but it appears that the brain is deprived
of oxygen and this results in the death of neurons. When the corticospinal tract is damaged, the
injury is usually manifested on the opposite side of the body. For example if one has an injury to
the right side of the brain, the hemiplegia will be on the left side of the body.

[edit] Signs and Symptoms

Hemiplegia means severe weakness of the limbs on one side of the body but the specific features
can vary tremendously from person to person. Problems may include:

• Difficulty with gait

• Difficulty with balance while standing or walking
• Having difficulty with motor activities like holding, grasping or pinching
• Increasing stiffness of muscles
• Muscle spasms
• Difficulty with speech
• Difficulty swallowing food
• Significant delay in achieving developmental milestones like standing,
smiling, crawling or speaking
• The majority of children who develop hemiplegia also have abnormal mental
development
• Behavior problems like anxiety, anger, irritability, lack of concentration or
comprehension
• Emotions- depression

[edit] Diagnosis
Hemiplegia is identified by clinical examination by a health professional, such as a
physiotherapist or doctor. Radiological studies like a CT scan or magnetic resonance imaging of
the brain should be used to confirm injury in the brain and spinal cord, but alone cannot be used
to identify movement disorders. Individuals who develop seizures may undergo tests to
determine where the focus of excess electrical activity is.[7]

[edit] Treatment
Treatment should be based on assessment by the relevant health professionals, including
physiotherapists, doctors and occupational therapists. Muscles with severe motor impairment
including weakness need these therapists to assist them with specific exercise, and are likely to
require help to do this. [8]

Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Drugs like
Librium or Valium could be used as a relaxant. Drugs are also given to individuals whom have
recurrent seizures, which may be a separate but related problem after brain injury.[9]

Surgery may be used if the individual develops a secondary issue of contracture, from a severe
imbalance of muscle activity. In such cases the surgeon may cut the ligaments and relieve joint
contractures. Individuals who are unable to swallow may have a tube inserted into the stomach.
This allows food to be given directly into the stomach. The food is in liquid form and instilled at
low rates. Prosthetics. Some individuals with hemiplegia will benefit from some type of
prosthetic device. There are many types of braces and splints available to stabilize a joint, assist
with walking and keep the upper body erect.

Rehabilitation is the main treatment of individuals with hemiplegia. In all cases, the major aim of
rehabilitation is to regain maximum function and quality of life. Both physical and occupational
therapy can significantly improve the quality of life. Physical therapy can help improve muscle
strength, mobility such as standing and walking, and other physical function. Occupational
therapy may help the individual train daily living activities like brushing teeth, combing hair or
dressing. Initially, one may undergo physical therapy at a center but many of these exercises can
also be done at home and become part of daily life routine.[10]

[edit] Prognosis
Hemiplegia is not a progressive disorder, except in progressive conditions like a growing brain
tumour. Once the injury has occurred, the symptoms should not worsen. However, because of
lack of mobility, other complications can occur. Complications may include muscle and joint
stiffness, loss of aerobic fitness, , muscle spasms, , bed sores, pressure ulcers and blood clots.[11]

Sudden recovery from hemiplegia is very rare. Many of the individuals will have limited
recovery, but the majority will improve from intensive, specialised rehabilitation. Potential to
progress may differ in cerebral palsy, compared to adult acquired brain injury. It is vital to
integrate the hemiplegic child into society and encourage them in their daily living activities.
With time, some individuals may make remarkable progress.

Hemiplegia (C0018991)
Definition (MSH)Severe or complete loss of motor function on one side of the body.
This condition is usually caused by BRAIN DISEASES that are localized to the
cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM
lesions; cervical SPINAL CORD DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES;
and other conditions may manifest as hemiplegia. The term hemiparesis (see
PARESIS) refers to mild to moderate weakness involving one side of the
body.Definition (CSP)severe or complete loss of motor function on one side of the
body; this condition is usually caused by brain diseases that are localized to the
cerebral hemisphere opposite to the side of weakness; less frequently, brain stem
lesions; cervical spinal cord diseases, peripheral nervous system diseases, and
other conditions may manifest as hemiplegia.Definition (NCI)Paralysis of one side of
the body.ConceptsSign or Symptom (T184)
ICD9342.9MSHD006429EnglishHemiplegia, Hemiplegias, paralysis of one side of
body, PARALYSIS ONE SIDE OF BODYSpanishhemiplejiaParent ConceptsSpinal Cord
Injuries (C0037929), Paralysed (C0522224), CNS disorder (C0007682), Brain
Diseases (C0006111), CNS GENERAL (C0549638), VASCULAR: INTRACRANIAL
(C0549642), Hemiplegia and hemiparesis (C0375206), Hemiplegia (C0018991),
Paralytic syndrome (C0270788), Disorder of extremity (C1290877)SourcesAOD,
CCS, COSTAR, CSP, CST, DXP, ICD9CM, LCH, MSH, NCI, NDFRT, OMIM, RAM, SCTSPA,
SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)

Total paralysis: A condition which is characterized by a total inability to move the

legs and arms.

there total paralysis of the muscles or weakness of the muscles?

Why: The terms hemiplegia and paraplegia strictly indicate total paralysis. Hemiparesis means
weakness of the limbs of one side. Paraparesis means weakness of both lower limbs.

Paralysis is the complete loss of muscle function for one or more muscle groups.
Paralysis can cause loss of feeling or loss of mobility in the affected area.

Paralysis may be localized, or generalized, or it may follow a certain pattern. Most

paralyses caused by nervous system damage (i.e. spinal cord injuries) are constant
in nature; however, there are forms of periodic paralysis, including sleep paralysis,
which are caused by other factors.
Causes
Paralysis is most often caused by damage in the nervous system, especially the spinal cord.
Major causes are stroke, trauma with nerve injury, poliomyelitis, amyotrophic lateral sclerosis
(ALS), botulism, spina bifida, multiple sclerosis, and Guillain-Barré syndrome. Temporary
paralysis occurs during REM sleep, and dysregulation of this system can lead to episodes of
waking paralysis. Drugs that interfere with nerve function, such as curare, can also cause
paralysis. Many causes of this are varied, and could also be unknown.

Pseudoparalysis (pseudo- meaning false, not genuine) is voluntary restriction or inhibition of

motion because of pain, incoordination, or other cause, and is not due to actual muscular
paralysis.[1] In an infant, it may be a symptom of congenital syphilis.[2]

What Are the Causes of Hemiplegia?

Contributor

By George N Root III, eHow Contributing Writer

Article Rating: (0 Ratings)

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During the very early stages of a child's life, there are many things that can hinder his healthy
development. Hemiplegia is a condition that can strike anytime during the early stages of a
child's development, and it remains with that child for the rest of his life.

Identification
1. 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 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.

Potential
2. According to brainandspinalcord.org, it is possible for an unborn child to
suffer from a stroke while still developing in the mother's womb. It is also
possible for newborn babies to suffer from a stroke as well. These strokes can
lead to brain disorders such as hemiplegia.

Types
3. Children who experience head injuries are at risk for contracting hemiplegia,
as well as children who develop tumors in the brain.
Many of the causes of 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
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.

Considerations
4. 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 hemiplegia.
 Effects
5. In many cases, for a child to experience the effects of hemiplegia, there
needs to be something that causes the episode to commence. 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.

paralysis of the muscles of the lower face, arm, and leg on one side of the body. The
most common cause of hemiplegia is damage to the corticospinal tracts in one
hemisphere of the brain due to obstruction or rupture of a cerebral artery or to brain
tumour. The corticospinal tracts extend from the lower spinal cord to the cerebral
cortex. They decussate, or cross, in the brainstem; therefore, damage to the right
cerebral hemisphere results in paralysis of the left side of the body. Damage to the
left hemisphere of a right-handed person may also result in aphasia.

1. Treat Hemiplegia by Relearning

Hemiplegia, or one-sided paralysis, is a very common outcome of a stroke. Recovering use of the
affected side of the body is often possible, at least to some degree. It takes months and
sometimes years to relearn and recover the function, but there is a general course that physical
therapists will take when working with stroke victims, since stroke is such a common medical
condition. Each person's stroke episode is different, but there are expected deficiencies
depending on the location in the brain where the tissue damage took place. Ask the stroke
victim's neurologist to give you a ballpark idea of what sort of recovery can be expected.

2. Learn New Ways to Move

At first, just moving around after a stroke can seem an insurmountable task. With one side of the
body paralyzed, life slows down a lot, but it need not stop. In the hospital, the physical therapists
will start as soon as possible to get a stroke survivor up and moving--usually within a few days
of the event. Beyond the hospital and even beyond a rehab center, stroke survivors usually begin
the mobility process in a wheelchair. Motorized wheelchairs can be operated by the person and
require the use of just one hand. As strength increases, the patient's physical therapist may
recommend a quad walker or other nonwheeled mobility device.
3. Eat Better With the Help of Assistive Devices

Even eating is difficult with just one functioning side. The occupational therapist can give
referrals to companies that produce items such as plate guards, nonslip bowls and cups and
rocking knives--all of which are designed to make eating with one hand a simple task.

4. Dress Yourself With the Help of Hook and Loop Tape

Hook and loop tape is a common example of the solutions that occupational therapists and
hemiplegia survivors have come up with to help with dressing and other so-called "activities of
daily living." Whether the Velcro is used on a shirt sleeve, shoes or pants, it makes for a sense of
independence during stroke recovery.

5. Be Patient With Hygiene and Toileting Needs

Treating the effects of hemiplegia includes learning to be independent in the bathroom. Bathing,
brushing teeth and using the toilet are multimovement processes, but physical and occupational
therapists will help the stroke survivor build up the strength and abilities to do it independently.
Hemiplegia is a condition that affects one side of the body in cerebral palsy patients, however it
is not exclusive to cerebral palsy. Hemiplegia affects either the right or left side of the body.
Hemiplegia is caused by damage to a part of the brain, which can occur before, during, or soon
after birth, when it is known as congenital hemiplegia. If it occurs later in childhood (up to age
3), it is called acquired hemiplegia. Generally, injury to the left side of the brain will cause a
right hemiplegia and injury to the right side a left hemiplegia. Childhood hemiplegia is a
relatively common condition, affecting up to one child in 1,000.

The causes of congenital hemiplegia are mostly unknown, and usually parents become aware of
their child's hemiplegia gradually during his or her infancy. The risk for hemiplegia is higher in
premature babies, and difficulty at birth may be an occasional factor. Brain damage causing
hemiplegia usually occurs during pregnancy, and researchers have as yet been unable to isolate
any contributory factors besides the previously known risk factors of cerebral palsy. Acquired
hemiplegia results from damage to the brain during childhood. The most common cause is a
stroke, but it can also result from an accident or infection.

Hemiplegia affects each child differently. The most obvious affects are a varying degree of
weakness and lack of control in the affected side of the body. In one child this may be very
obvious, in another child it will be so slight that it only shows when attempting specific physical
activities.

Although there is no cure for hemiplegia, its effects can be minimized through physical therapy.
Your child, once diagnosed, will probably be referred to a Child Development Centre (CDC) or
the children's department of your local or regional hospital, where therapists will work with you
to develop his or her abilities.

Because the immature brain is so flexible, many of the functions of the damaged area can be
taken over by completely functional parts of the brain. Children and young people with
hemiplegia will see a relatively small difference in their general development in the area of the
brain that was damaged, especially in comparison to their elder counterparts.

A child with hemiplegia should be treated as normally as possible, when the circumstances
allow. However, it is essential to include the weaker side in play and everyday activities, to make
your child as ambidextrous as possible. Children with hemiplegia can be encouraged to develop
better use of their weaker side through involvement in their chosen sports and hobbies, as they
get older.

About half of children with hemiplegia do have additional problems related to cerebral palsy.
Additional problems are usually medical in nature, such as epilepsy, visual impairment or speech
difficulties. It has also become clear that many children have less obvious additional problems,
such as perceptual problems, specific learning difficulties or emotional and behavioral problems,
but with specialist treatment their effects on the child's life can be minimized.
Understanding hemiplegia and knowing how you can help your child achieve his or her potential
is vital. Make good use of the healthcare specialists dealing with your child's hemiplegia. Be sure
to ask questions and make sure you understand your child's needs regarding hemiplegia.

Case report
Hemiplegic migraine: Hyperperfusion and abortive therapy
with intravenous verapamil
David A. Hsu
a,*
, Carl E. Stafstrom
a,b
, Howard A. Rowley
c
,
Jane E. Kiff
d
, Douglas A. Dulli
a
a
Department of Neurology H6/526, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA
b
Department of Pediatrics, University of Wisconsin, Madison, WI 53792, USA
c
Department of Radiology, University of Wisconsin, Madison, WI 53792, USA
d
Department of Pediatrics, Rhode Island Hospital, Brown University, Providence, RI 02903, USA
Received 27 February 2007; received in revised form 23 April 2007; accepted 24 May 2007
Abstract
A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproduc-
ibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic
(CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion
concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine.
The beneficial effect of verapamil on headache but not hemiplegia suggests a distinct mechanism for pain and neuronal dysfunction
in hemiplegic migraine, with the beneficial effect on pain not due to vasodilation.
Ó 2007 Elsevier B.V. All rights reserved.
Keywords: Hemiplegic migraine; Intravenous verapamil; Cerebral perfusion
1. Introduction
Much has been learned about migraine physiology
and biochemistry but a causative mechanism has
remained elusive
[1,2]
. At baseline, neocortical neurons
are diffusely hyperexcitable in migraineurs. With aura
onset, there is focal hyperemia followed by spreading oli-
gemia (cortical spreading depression, CSD). The olige-
mic phase may last into the headache phase and
correlates with neuronal dysfunction. Migraine pain is
associated with peripheral and central trigeminal
activation, dural inflammation and plasma extravasa-
tion, central sensitization, and abnormal nociceptive
neuromodulatory centers in the brainstem; vasodilation
is seen inconsistently
[1,2]
.
The mechanism of hemiplegic migraine may or may
not be the same as that for classic migraine. We present
a patient with recurrent hemiplegic migraines associated
with cerebral hyperperfusion concurrent with and con-
tralateral to the hemiplegia. Her headaches but not
hemiplegia
resolved
promptly
with
intravenous
verapamil.