This document discusses the causes of hemiplegia, which include stroke, central nervous system infections, demyelination disorders, trauma, hemiplegic migraines, and vasculitis. Stroke is described in more detail, with the main causes being cerebral infarction, primary intracerebral hemorrhage, and subarachnoid hemorrhage. Risk factors for stroke include conditions like hypertension, heart disease, diabetes, and lifestyle factors such as smoking. The pathophysiology of cerebral infarction and primary intracerebral hemorrhage are also summarized.

2. CAUSES OF HEMIPLEGIA
 STROKE
 CNS INFECTION- MENINGITIS, ENCEPHALITIS
 DEMYELINATION- MULTIPLE SCLEROSIS , POST
INFECTIOUS
 TRAUMA
 HEMIPLEGIC MIGRAINE
 TODD’S PARALYSIS VASCULITIS

3. STROKE
 ACUTE STROKE _RAPID APPEARANCE OF A FOCAL
DEFICIT OF BRAIN FUNCTION , WITH OR
WITHOUT SIGNS OF FOCAL HIGHER CEREBRAL
DYSFUNCTION , HEMISENSORY LOSS, VISUAL FIELD
DEFECT OR BRAIN STEM DEFECT
 MEDICAL EMERGENCY

4. TERMS RELATED
 TRANSIENT ISCHEMIC ATTACK – RESOLVE
WITHIN 24 HRS
 STROKE- LAST MORE THAN 24 HRS
 STROKE IN EVOLUTION- FND PROGRESSING
 COMPLETED STROKE-FND PERSISTS –NOT
PROGRESSING

5. CAUSES OF STROKE
 CEREBRAL INFARCTION
 PRIMARY INTRACEREBRAL HAEMORRHAGE
 SUB ARACHNOID HAEMORRHAGE

6. PATHOPHYSIOLOGY
 CEREBRAL INFARCTION
 CARDIAC EMBOLISM - MCA PCA
 ATHEROSCLEROSIS – CAROTID ARTERY
 ARTERIAL DISSECTION NEUROSYPHILIS
 THROMBOPHILIA VASCULITIS
 HOMOCYSTINURIA SLE APLA SYNDROME
 SICKLE CELL ANAEMIA - CHILDREN

7. RISK FACTORS
FIXED MODIFIABLE
AGE HYPERTENSION
GENDER HEART DISEASE
HEREDITY , DM HYPERLIPIDEMIA
RACE
MI STROKE SMOKING ALCOHOL OCP
HIGH POLYCYTHEMIA
FIBRINOGEN

8. CEREBRAL INFARCTION
 Occlusion of cerebral artery
opening of anastomotic channels
perfusion restored
 Homeostatic mech fail
ischemia & infarction
neuronal functions fail
neurological deficit

9. Infarction (Continued)
 Ischemia persists _ hypoxia _ inadequate ATP supply
_ failure of membrane pumps_ influx of Na & water
_cytotoxic edema_glutamate release _ influx of Na &
Ca_ enzyme activation _ irreversible cell death
 Lactic acid accumln & fall in pH

10. PRIMARY INTRACEREBRAL
HAEMORRHAGE
 ARTERIOVENOUS MALFORMATION
 DRUG MISUSE- AMPHETAMINE , COCAINE
 COAGULOPATHY
 Rupture of blood vessel within brain parenchyma _
explosive entry of blood _ structural disruption of
neurons_ progression of neurological deficit

11. CAUSES & RISK FACTORS
COMPLEX SMALL VESSEL AGE HT
DISEASE N VESSEL WALL
DISRUPTION
AMYLOID ANGIOPATHY FAMILIAL AGE
IMPAIRED BLOOD ANTICOAGULANT
CLOTTING THERAPY , BLOOD
DYSCRASIA
VASCULAR ANOMALY AV MALFORMATION
CAVERNOUS
HEMANGIOMA
SUBSTANCE MISUSE ALCOHOL
AMPHETAMINE COCAINE

12. SUB ARACHNOID HAEMORRHAGE
 LESS COMMON – WOMEN MORE AFFECTED
Saccular aneurysm AVM Vertebral dissection
 Berry aneurysm- region of circle of Willis
 First degree relatives
 Polycystic kidney disease Ehlers Danlos Syn
 Non aneurysmal haemorrhage (peri-mesencephalic
haemorrhage)

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