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Clinical features of hemiplegia
 

Clinical features of hemiplegia

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    Clinical features of hemiplegia Clinical features of hemiplegia Presentation Transcript

    • CLINICAL FEATURES OF HEMIPLEGIA
    • HEMIPLEGIA• Weakness of one half of body with or without involvement of face• PRESENTATION OF UNILATERAL LESIONABV C5 LEVEL OFSPINAL CORD
    • • How was the onset and how did it progress???
    • ONSET AND PROGRESS• THROMBOTIC• EMBOLIC• HEMORRHAGIC
    • THROMBOTIC STROKE• Onset during sleep or on rising• Usually in elderly• Stepwise evolution• Preservation of consiousness• Gradual recovery
    • • No seizure or headache• h/o prodromal TIA’s• Evidence of atheroscelerosis
    • EMBOLIC• Abrupt development of completed stroke within few seconds• Rapid improvement within minutes or hours• Occur at any time• Relative preservation of consiousness• Occur in any age
    • • Localised headache,seizures +• Rapid recovery• Evidence of recent stroke• No history of prodromal TIA
    • HEMORRHAGIC• Presence of hypertension• Onset during walking hours• Headache +/_ , seizure+ , vomiting +• Deepening stupor/ coma• Gradual development
    • • Nuchal rigidity• Delayed or no recovery• Absence of prodromal symptoms
    • • LOCALIZATION ????
    • PYRAMIDAL TRACTUMN LMN• Weakness in the • Weakness in the spinal corticospinal dist segment dist• Distal muscle groups • Wasting• Axial movts are spared• Extraocular,upper facial,pharyngeal,jaw muscles are spared
    • • Hypertonia • Hypotonia• Exaggrated tendon • Loss of tendon reflex reflex • Muscle wasting• No muscle wasting • Fasciculation &• Extensor plantar contracture of affected response muscle• Loss of abdominal • Trophic changes in skin reflexes nail
    • What the patient complaints off ????• Stiffness of legs• Unable to walk on rough ground• Diff.to climb stairs• Vibration of limb while stepping down the stairs- ankle conus• Finally,dragging of foot,stiff legged gait,keeps tripping over,shoes wearing off
    • Features of extrapyramidal lesion• Difficulty to initiate voluntary movt• Hypertonia-rigidity• No loss of power of muscles• Bradykinesia• Inv movts• Postural instability
    • Associated features
    • • Headache and vomiting• Altered level of consiousness• Seizure• Speech abnormality• Altered behaviour• Bowel and bladder involvement
    • Cerebellar symptoms• Wide based gait• Scanning speech• Nystagmus,tendency to fall• Weakness due to hypotonia(pendular knee jerk)• Dysdiadocokinesis• Dysmetria• Intention tremor
    • POSTERIOR TRACT INV• Diff.to stand ,walk• Positive rombergs sign• Stamping gait• Unable to walk in dark
    • cranial nerve involvement