Clinical features of hemiplegia

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Clinical features of hemiplegia

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

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