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CLINICAL FEATURES OF
      HEMIPLEGIA
HEMIPLEGIA
• Weakness of one half of body with or
  without involvement of face

• PRESENTATION OF
 UNILATERAL LESION
ABV C5 LEVEL OF
SPINAL 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 TRACT
UMN                        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
Clinical features of hemiplegia
Clinical features of hemiplegia
Clinical features of hemiplegia

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Clinical features of hemiplegia

  • 1. CLINICAL FEATURES OF HEMIPLEGIA
  • 2. HEMIPLEGIA • Weakness of one half of body with or without involvement of face • PRESENTATION OF UNILATERAL LESION ABV C5 LEVEL OF SPINAL CORD
  • 3. • How was the onset and how did it progress???
  • 4. ONSET AND PROGRESS • THROMBOTIC • EMBOLIC • HEMORRHAGIC
  • 5. THROMBOTIC STROKE • Onset during sleep or on rising • Usually in elderly • Stepwise evolution • Preservation of consiousness • Gradual recovery
  • 6. • No seizure or headache • h/o prodromal TIA’s • Evidence of atheroscelerosis
  • 7. 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
  • 8. Localised headache,seizures + • Rapid recovery • Evidence of recent stroke • No history of prodromal TIA
  • 9. HEMORRHAGIC • Presence of hypertension • Onset during walking hours • Headache +/_ , seizure+ , vomiting + • Deepening stupor/ coma • Gradual development
  • 10. • Nuchal rigidity • Delayed or no recovery • Absence of prodromal symptoms
  • 12. PYRAMIDAL TRACT UMN 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
  • 13. • 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
  • 14. 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
  • 15. Features of extrapyramidal lesion • Difficulty to initiate voluntary movt • Hypertonia-rigidity • No loss of power of muscles • Bradykinesia • Inv movts • Postural instability
  • 17. Headache and vomiting • Altered level of consiousness • Seizure • Speech abnormality • Altered behaviour • Bowel and bladder involvement
  • 18. Cerebellar symptoms • Wide based gait • Scanning speech • Nystagmus,tendency to fall • Weakness due to hypotonia(pendular knee jerk) • Dysdiadocokinesis • Dysmetria • Intention tremor
  • 19. POSTERIOR TRACT INV • Diff.to stand ,walk • Positive rombergs sign • Stamping gait • Unable to walk in dark