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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:
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


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
Touch level of
lesion
2-Brain stem
2-Pontine lesions
1-Mid-brain lesion 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