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Hemiplegia

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 5 th cervical segment. Causes :- 1-Vascular causes:- A)-Thrombotic :-

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Hemiplegia

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  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. 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 sideofthe body.

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

  12. 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 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--------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

  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

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