Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body (hemi- means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke
Hypenension: Commonest cause of intracerebral haemorrhage.
Rupture of an intracranial aneurysm, angioma or A-V malformation: commonest cause of subarachnoid haemorrhage.
Haemorrhagic blood diseases: purpura, haemophilia.
Anticoagulants.
Trauma to the head: commonest of subdural haematoma.
II. Infective: ;
Encephalitis
Meningitis – Brain abscess.
III. Neoplastic: e.g. Meningioma.
IV. Demyelination: multiple sclerosis may present with hemiplegia.
V. Traumatic: e.g. Cerebral laceration and subdural haematoma.
VI. Hysterical: patient suffering from paralysis in the absence of organic lesion.
3. 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 (beginning of origin
of brachial plexus).
9. 1. Intracerebral: the bleeding is in the brain
substance & may leak into the ventricles; The
commonest artery causing intracerebral hge is
the lenticulo-stnate branch of the middle
cerebral artery.
2. Subarachnoid: the bleeding is in the
subarachnoid space
11. Symptoms & signs: Vary according to the
onset:
Acute lesions: the clinical picture passes
through 2 stages:
Stage of flaccidity due to neuronal shock.
Stage of spasticity which is the stage of
established hemiplegia.
Gradual lesions: the hemiplegia passes directly
to the stage of spasticity.
12. Stage of flaccid paralysis (shock stage):
It lasts from 2-6 weeks.
It is characterized by ↓tone (flaccidity), ↓ or
lost deep reflexes and absent plantar
response.
During recovery from the shock stage, the
muscle tone & deep reflexes reappear &
gradually increase, Babinski sign becomes
+vethen, stage of spasticity sets in.
31. Fibres descending from the cortex
are called the ‘corona radiata’
cortex
C.R.
I.C.
To
LMN
Brainstem
Reticular
formation
Subcortical
•In-between
البنين بين
32. In which vascular syndrome
is the facial nerve affected:
1. Dejerine
2. Avellis
3. Millard-Gubler
4. Brown-Sequard
33. Labs: blood glucose, liver and kidney functions,
lipid profile, CBC.
Imaging:
CT brain: to detect presence of infarction,
haemorrhage , brain tumor.
MRI brain: to detect presence of infarction,
haemorrhage, brain tumor, encephalitis, M.S.
plaques.
34.
35.
36.
37. Vascular imaging
Doppler ultrasonic imaging: for carotid and
vertebrobasilar arteries.
Transcranial Doppler (TCD), CT Angiography, MR
Angiography.
Digital subtraction angiography: It visualises the
intracerebral vessels. It is non-invasive as it requires a
contrast medium given I.V.
Cerebral angiography: It is the most precise method,
showing any occlusion or stenosis in the cerebral
vascular tree.
Other investigations according to the cause:
echocardiography and ECG in cardiac cases.
38.
39. General
Care of the skin:
Frequent change of the patient's position
(every 2 hours), and of the bed sheets.
Frequent wash of the skin of the back and
pressure points.
Suction of nasal and pharyngeal secretions.
O2 inhalation via catheter or mask specially
in cases of coma.
Tracheostomy in urgent cases.
40. Care of nutrition and fluid balance:Tube feeding
giving fruit juices, milk and pureed food,
besides I.V. fluids, in comatosed patients.
Care of the urinary bladder:Foley's self-
retaining catheter in case of retention.
Guarding against D.V.T.: by subcutaneous
injection of anticoagulant and wearing elastic
stocks.
41. II. Specific: It is the treatment of the cause.
A) If the cause is cerebral thrombosis:
Control of vascular risk factors: such as
hypertension and D.M. and dyslipidaemia
Antiplatelets: because platelet aggregation is
increased after thrombosis e.g. aspirin,
dipyridamole,clopidogril.
Nootropic drugs: e.g. piracetam and pentoxifylline.
42. B) If the cause is cerebral embolism:
Treatment of the source of emboli.
Anticoagulants are given in cardiac cases to
prevent further embolisation specially in
cases of A.F.
43. C) If the cause is cerebral haemorrhage:
General care
Control of vascular risk factors: such as
hypertension and D.M. and dyslipidaemia
Surgical evacuation: of the haematoma in
certain conditions.
44. D) If the cause is cerebral inflammation:
Treatment of meningitis and encephalitis
E) If the cause is brain tumors: Surgical
removal.
E) If the cause is M.S.: Pulse steroid therapy.
45. III. Physiotherapy:
Proper positioning of the hemiplegic side.
Passive and active exercises (after stabilisation
of the neurological condition) to minimise
contractures & to strengthen the muscles.
NO MASSAGE