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Hemiplegia
Classification and external resources
ICD-10 G80.2, G81.
ICD-9 342-343, 438.2
MeSH D006429

Hemiplegia is a condition in which half of a body has compromised motoric functions. Hemiplegia is more severe than hemiparesis, wherein one half of the body is weakened but not paralysed.[1] Hemiplegia may be congenital or acquired from an illness or stroke.

Hemiplegia is not an uncommon medical disorder. In elderly individuals, strokes are the most common cause of hemiplegia. In children, the majority of cases of hemiplegia have no identifiable cause and occur with a frequency of about one in every thousand births. Experts indicate that the majority of cases of hemiplegia that occur up to the age of two should be considered to be cerebral palsy until proven otherwise. [2]

Contents

Causes

The most common cause of hemiplegia is a cerebrovascular accident, also known as a stroke. Strokes may also cause less severe conditions like hemiparesis and spasticity, however these could be minimized through rigorous post-trauma physical therapy.[3]

Alternate causes of hemiplegia include any spinal cord injury, specifically Brown-Séquard syndrome, traumatic brain injury, or other disease affecting the central nervous system. Injury to only one of the cerebral hemispheres is more likely to cause hemiplegia. In cerebral palsy, damage to the hemisphere may limit function or cause spasticity without resulting in total paralysis of one half of the body.

It is well known that the incidence of hemiplegia is a lot higher in premature babies than term babies. There is also a high incidence of hemiplegia during pregnancy and experts believe that this may be related to either a traumatic delivery, use of forceps or some event which causes brain injury. [4]

Hemiplegia in adults include trauma, bleeding, brain infections and cancers. Individuals who have uncontrolled diabetes, hypertension or those who smoke have a higher chance of developing a stroke. In some cases, only the face may be paralyzed. Facial hemiplegia may occur on one side of the face and may be due to a viral infection, stroke or a cancer. [5]

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Medial medullary syndrome

Common causes by etiology

Pathogenesis

The exact cause of hemiplegia is not known in all cases, but it appears that in all cases the brain is deprived of oxygen and this results in the death of neurons, leading to hemiplegia. When hemiplegia occurs, the injury is usually manifested on the opposite side of the body. For example if one has an injury to the right side of the brain, the hemiplegia will be on the left side of the body.

Symptoms

Hemiplegia means paralysis of one side of the body but the clinical features can vary tremendously. Both the symptoms and intensity are variable from person to person. The classic symptoms include:

  • Difficulty with gait
  • Difficulty with balance while standing or walking
  • Having difficulty with fine motor activities like holding, grasping or pinching
  • Increasing stiffness and rigidity of joints
  • Muscle spasms
  • Seizures
  • Inability to hold bladder or bowel
  • Difficulty with speech
  • Difficulty swallowing food
  • Significant delay in achieving developmental milestones like standing, smiling, crawling or speaking
  • The majority of children who develop hemiplegia also have abnormal mental development and have a low IQ
  • Behaviors problems like anxiety, anger, irritability, lack of concentration or comprehension
  • Emotions- depression
  • Adults can have the same symptoms as children when hemiplegia occurs

Diagnosis

The diagnosis of hemiplegia includes some blood tests and radiological studies like a CT scan or magnetic resonance imaging of the brain. Individuals who develop seizures may undergo tests to determine where the focus of excess electrical activity is. [8]

Treatment

Unfortunately, even if the cause of hemiplegia is known, there is no cure for it. Once brain injury has occurred, the only available treatments are to ease the symptoms and improve the quality of life. Drugs are used to treat painful mucle spasms. Drugs like Librium or Valium are frequently administered to help break up muscle spasms and also help to calm the ill person. Drugs are also given to individuals whom have recurrent seizures. [9]

Surgery has a very small role in the treatment of hemiplegia. Some individuals may develop joint contractures and acquire severe deformities of the joints. In such cases the surgeon may cut the ligaments and relieve joint contractures. Individuals whom are unable to swallow may have a tube inserted into the stomach by the surgeon. This allows food to be given directly into the stomach. The food is blended or pureed and instilled at low rates. Prosthetics. The majority of individuals with hemiplegia will benefit from some type of prosthetic device. There are many types of braces and splints available to stabilize the joint, assist with walking and keep the upper body erect. Some of the air filled braces are comfortable and can even be worn at night.

Rehabilitation is the main treatment of individuals with hemiplegia. In all cases, the major aim of rehabilitation is to regain maximum functioning potential of the brain. Both physical and occupational therapy can significantly improve the quality of life. Physical therapy can help improve the range of motion, increase muscle strength and prevent joint contractures. Occupational therapy may help the individual perform daily living activities like brushing teeth, combing hair or dressing. Initially, one may undergo physical therapy at a center but many of these exercises can also be done at home and become part of daily life routine. [10]

Prognosis

Hemiplegia is not a progressive disorder. Once the injury has occurred, the symptoms remain the same. However, because of lack of mobility, other complications do occur. The complications include joint contractures, muscle spasms, joint deformities, bed sores, pressure ulcers and blood clots. [11]

Sudden recovery from hemiplegia is very rare. Only the very mild cases may improve but most severe cases of hemiplegia have a poor prognosis. Many of the individuals will become bed bound or may have to use a wheel chair to get around. When one side of the body is paralyzed, it is difficult to use a cane or crutches. It is vital to integrate the hemiplegic child into society and encourage them in their daily living activities. With time, some individuals may make remarkable progress. [12]

See also

References

  1. ^ Hemiplegia/Hemiparesis
  2. ^ Hemiplegia symptoms, treatment and therapy Retrieved on 2010-02-02
  3. ^ Patten C, Lexell J, Brown HE. Weakness and strength training in persons with poststroke hemiplegia: Rationale, method, and efficacy. J Rehab Res Dev 2004;41:293-312. PMID 15543447.
  4. ^ Hemiplegia in children Children's hemiplegia and stroke association. Retrieved on 2010-02-02
  5. ^ What is Hemiplegia HemiHelp Portal. Retrieved on 2010-02-02
  6. ^ http://www.samehlabib.com/Books/Neurology.doc
  7. ^ http://www.lakesidepress.com/pulmonary/Sleep/sleep-paralysis.htm
  8. ^ Forms of cerebral palsi: Hemiplegia Origins of cerebral palsi Online Portal. Retrieved on 2010-02-02
  9. ^ Hemiplegia and hemiparesis Gait disorders Portal. Retrieved on 2010-02-02
  10. ^ Hemiplegia definition About Online Portal. Retrieved on 2010-02-02
  11. ^ Hemiplegia overview, causes and risk factors Healthopedia Portal. Retrieved on 2010-02-02
  12. ^ Hemiplegia review guide Organized wisdom Portal. Retrieved on 2010-02-02

External links


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