Hemiplegia: causes, symptoms, therapy after stroke

Spastic hemiplegia is a form of cerebral palsy (CP) in which half the body is affected. The condition is manifested by paralysis of the arm and leg on one side, severe cognitive impairment, and a pathological motor stereotype. Less commonly, the damage is bilateral, and hemiplegia is double. The disease is diagnosed based on the results of a neurological examination, neuroimaging using ultrasound, MRI and CT, and electrophysiological studies. Complex treatment includes medications and physical rehabilitation methods. orthopedic correction.

General information

The hemiplegic (hemiparetic) variant of cerebral palsy accounts for about 30% of all cases of the disease, second only to spastic diplegia, which accounts for up to 40% of the incidence structure. Double spastic hemiplegia is a separate form - the most severe variant of the disease, which is actually tetraparesis. The overall incidence of cerebral palsy in Russia is 2.2-3.3 cases per 1000 live births, with no downward trend.

Spastic hemiplegia

Hemiplegia ingilizcede ne demek, Hemiplegia nerede nasl kullanlr

Hemiplegia laryngis: Kısmi gırtlak felci. Hemiplejiya larenks.

Larengeal hemiplegia: Larenks felci. Gırtlak felci.

Laryngeal hemiplegia: Kısmi gırtlak felci. Atlarda, sol nervus laryngeus rekurrensin basınca bağlı dejenerasyonu sonucu, gırtlağı sol bölümünün felci ve sinir kökenli atrofisi, larengeal hemipleji, hemiplejiya larenks, kornaj, tıslak. hayvanın nefes alıp vermesi sırasında hırıltı sesi veya boğulma benzeri belirtilere neden olur. Larengeal hemipleji.

Hemiplegic: Yarım felç olan. Yarı felç olan. Hemiplejik. Hemipleji (vücudun bir parçasının işlevini yitirmesi durumu) yaşayan.

Equine larygeal hemiplegie: Kısmi gırtlak felci. Kornaj.

Hemiplankton : Hayat evresinin sadece belli bir dönemini planktonik olarak geçiren organizmalar. Hemiplankton.

Hemiplegy: Kısmi felç. Yarım felç.

İngilizce Hemiplegia Türkçe anlamı, Hemiplegia eş anlamlısı

Sözcükler, direkt olarak Hemiplegia ile ilgili eş anlamlı kelimeler olmayabilir. Kelime anlamı benzer olan sözcükler olabilirler.

Hemiparalysis: Hemiparalysis.

Abdominal fat necrosis: Karın yağı nekrozu. Karın içi yağ nekrozu.

A crochordon: Akrokordon. Köpeklerde küçük, kılsız, hiperplastik bir epidermisle damardan zengin kollajen dokudan ibaret, saplı veya sapsız, deri eklentileri içermeyen, deri sarkmalarıyla belirgin iyicil tümör, fibrovasküler papillom, yumu şak fibrom, pendilöz yumuşak fibrom.

A c deformity: Ac kusuru. Arnold-chiari yapılış bozukluğu.

A c syndrom: Ac sendromu. Arnold-chiari yapılış bozukluğu.

Abdomen: Batın. Sindirim organları, karaciğer ve böbreklerin içinde bulunduğu ve göğüs boşluğundan bir diyaframla ayrılan vücut boşluğu, abdomen. Abdomen. Karin. Karın (böcek gövdesinde). Karnın altı. Böcek govdesinin alt kısım.

Abattoir: Kesimevi. Mezbaha. Salhane. Hayvanların etleri için kesildikleri yerler, hlk. ekdi.

Abdominal palpation: Karın bölgesinin elle muayenesi. Abdominal palpasyon. Avuç içi, parmak veya yumrukla çok hafif basınç uygulayarak karın bölgesindeki değişikliklerin niteliğini anlamak için yapılan muayene, abdominal palpasyon.

Abdominal pain. Abdominal ağrı. Karın ağrısı.

Palsy: Sürekli titremeye yol açan hastalık. Titreme. Kötürüm yapmak. Inme. Acizlik. Felç. Nüzul. Sarsaklık. Felce uğratmak. Felç olmak.

Hemiplegia synonyms: unilateral paralysis, paralysis, paraplegia, hemiplegy, paresis, a clay, abdominal distention, a dna, abaxial, a band, abamectin, abdominal ovariectomy, hemiparesis, a amplitude mod.

Hemiplegia ingilizce tanımı, definition of Hemiplegia

Hemiplegia kelimesinin İngilizce – İngilizce çevirisi (English to English) : A palsy that affects one side only of the body.

Causes

Spastic hemiplegia is a polyetiological disease that occurs due to the combined action of negative prenatal, intranatal and postnatal factors, with intrauterine brain damage accounting for up to 80% of the causes of cerebral palsy. The disease is caused by unilateral (sometimes bilateral, that is, double) cerebral damage. Modern neurology has described more than 400 causes of the development of cerebral palsy, among which the most significant are the following types:

• Premature birth. The condition is detected in 1% of premature babies, while in full-term babies it occurs 3-10 times less often. The weight of the baby at birth is of great importance: with a body weight of 1.5-2.5 kg, the pathology is diagnosed in 5-15% of patients, and with a weight below 1.5 kg - in 25-30% of cases.
• Head injuries. Intracranial injuries sustained during childbirth are a common cause of cerebral palsy in children. A high risk of spastic-plegic disorders exists in cases of birth asphyxia due to a complicated course of labor. However, up to 75% of patients with a history of birth trauma have other risk factors for cerebral palsy.
• Pathologies of pregnancy. The risk of developing spastic, including double, hemiplegia increases if there is a history of abnormal placental circulation, placental previa or abruption, or an immunological conflict between mother and fetus. Extragenital diseases of the mother and taking neurotoxic drugs during pregnancy also have a negative impact.
• Burdened heredity. Progressive spastic forms of cerebral palsy, especially double hemiplegia, may be a manifestation of undifferentiated genetic syndromes. The doctor should be alert to the presence in the family history of cases of miscarriage, infant deaths, and the birth of children with congenital anomalies.
• Postnatal factors. The causes of spastic hemiparesis can be strokes, shaken baby syndrome, severe forms of encephalitis and meningitis. More rare provoking factors include intoxication, episodes of brain hypoxia, and kernicterus.

What causes the violation

Factors that can lead to hemiplegia are quite diverse:

• cerebral and spinal strokes , in which the blood supply to the area of ​​the brain with the motor tract passing through it is stopped;
• brain and spinal cord injuries;
• infectious lesions of the central nervous system;
• extensive diffuse foci of ischemia of a discirculatory nature;
• brain tumors;
• functional disorders , in particular hysterical neurosis, in this case the pyramidal tract is preserved, and hemiplegia (hemiparesis) is a manifestation of pathological psycho-emotional reactions of a person.

Most of all manifestations of hemiplegia are acquired as a result of certain organic damage to the brain and spinal cord.

However, there are also congenital variants in which the baby is already born with a disorder. This is a consequence of improper formation of central motor neurons during embryogenesis or other disorders of cerebral and spinal functions during fetal development.

As a rule, this is not one, but several reasons at once, manifested by hemiplegia or delayed formation of cerebral structures.

Most often, the basis of pathogenesis is dyscirculatory disorders of the intracerebral, utero- and fetoplacental circulation, leading to dysgenesis and malformations of the newborn’s brain.

Pathogenesis

The pathomorphological basis of the condition in premature newborns is periventricular hemorrhagic cerebral infarction or congenital cerebral anomalies (schizencephaly). In full-term infants, the immediate cause of the disease is ischemic infarction and intracerebral hemorrhage due to birth trauma. Double hemiplegia occurs with bilateral damage to brain tissue.

Due to an organic cerebral defect, muscle tone increases, which leads to disturbances in the formation of righting reflexes. With unilateral injuries, changes affect only the contralateral (opposite to the lesion) side of the body, which is due to the structural features of the motor pathways. Spastic double hemiplegia is usually accompanied by signs of cranial nerve pathology.

Forms

It should be noted that medical experts distinguish different forms of hemiplegia

That is why it is important for a person to determine which particular variation of the disease he has encountered. It will be possible to specify the type after visiting a medical specialist.

You can only guess on your own what exactly you have to deal with.

First of all, pathology occurs functional and organic. If we talk about damage to the motor neuron, then there is spastic hemiplegia (central), as well as peripheral (flaccid).

The specific type depends on the area in which the lesion is located. Depending on the location of the muscles involved in the process, right-sided and left-sided hemiplegia occurs.

Separately, it should be noted that the disease can be contralateral, in which case central damage occurs on the opposite side. There is also a type called homolateral - a peripheral lesion occurs at the site of the outbreak. Double hemiplegia is slightly less common.

Separately, the disease is classified according to the level of damage:

• Cortical (the disease affects the cerebral cortex).
• Cortical-subcortical.
• Supracapsular (the lesion is located closer to the internal capsule).
• Alternating. The cranial nerves on the affected side are affected, while hemiplegia directly develops in the opposite area.
• Cross. The lesion occurs at the intersection of the fibers of the tract.
• Spinal. There is no damage to the cranial nerves.
• Alternating optical-pyramidal. One-sided blindness is observed in the affected area, while hemiplegia develops in the opposite area.

In addition, doctors divide the disease depending on its stage. There is a diaschisal variant; it appears during an acute period of coma due to shock changes that have occurred in the brain. There is a progressive type, it is observed with a prolonged and increasing course of the underlying disease. There is a regressive form, it is noted when the clinical picture improves.

During diagnosis, the specialist must note what type of pathology is being dealt with. Regardless of whether a person has double hemiplegia or spastic hemiplegia, in any case it will be necessary to begin proper treatment. Only in this situation will there be a chance to significantly improve well-being and restore the person’s health.

Symptoms of spastic hemiplegia

As a rule, the disease causes paresis or paralysis of the upper and lower limbs on one side. More often, with cerebral palsy, the muscles of the arm are involved in the process, while the leg partially retains its functionality. Double hemiplegia is manifested by total paresis of all limbs, which is why patients from an early age are unable to move independently and are extremely limited in voluntary movements.

Signs of the hemiplegic variant of cerebral palsy appear mainly in the first year of a child’s life. A lag in physical development and a lack of skills characteristic of a certain age (holding the head, sitting, crawling, walking) become noticeable. When parents try to put the child on his feet, he rests only on his toes, and not on his full foot, and transfers the weight to his healthy leg. The growth retardation of paretic limbs gradually worsens.

The motor stereotype in patients with cerebral palsy with spastic hemiplegic disorders has a number of features. Pathological tonic reflexes that increase in an upright position, synkinetic activity during voluntary movements, and disorders of the coordinating interaction of antagonist muscles are determined. Also typical is increased reflex excitability - the startle reflex.

Many patients have cognitive impairment: mental retardation of varying severity, learning disability, general mental retardation. Intellectual decline is aggravated by speech disorders, hearing loss, and visual impairment, which together causes significant social maladjustment. Often, patients with spastic cerebral palsy exhibit convulsive syndrome.

Diagnosis

A number of tests are used to detect hemiparesis. Barre's test - a paretic leg raised upward in a lying patient gradually lowers, while the healthy leg is held in its given position. Mingazzini test - the paretic arm extended forward is lowered, while the healthy one is held at a horizontal level. Garkin's test - the patient bends the forearm and vertically raises the hand with the fingers wide apart; on the paretic side, the first finger in the metacarpal joint slowly moves in the adduction position and bends slightly. Hoffmann's sign - the patient holds his hands palms down, and the tip of the middle finger is in contact with the examiner's fingers; in response to a sharp push of the middle finger, all fingers of the paretic hand flex. Venderovich's symptom - weakness of adduction of the fifth and fourth fingers - is an early sign of pyramidal insufficiency. Character of the pathol. the process that caused G. is recognized with the help of special wedges and studies.

Differential diagnosis

Pyramidal hemiplegia differs from cerebellar hemiplegia in the absence of cerebellar symptoms and muscle hypertension. In multiple sclerosis, pyramidal G. (paresis) with muscle hypotonia is observed as a result of combined damage to the pyramidal system and the cerebellum. With severe hemiparkinsonism in paralyzed limbs, plastic hypertension is observed with the cogwheel symptom and postural reflexes of Westphal and Thévenard-Foix. Pyramidal G. differs from hysterical (functional) by the presence of patol. reflexes, Wernicke-Mann gait.

Complications

Constant muscle tension and disproportionate development of the limbs results in severe joint contractures, lateral deformation of the spine, and changes in the shape of the chest. Pathological processes aggravate motor deficits, so over time, patients lose the ability to move independently and cannot perform purposeful movements. Often cerebral palsy is combined with chronic pain syndrome.

In cerebral palsy, gastrointestinal pathologies are often disturbing: dysphagia, gastroesophageal reflux disease, intestinal motility disorders. Patients often encounter dental problems: enamel hypoplasia, malocclusion, bruxism. The condition is accompanied by malnutrition, which leads to delayed bone age, false microcephaly, and calciopenia.

Gait analysis in children with cerebral palsy

Gait analysis in children with cerebral palsy

Thus, children with cerebral palsy have different types of gait disorders. It is clear that the effectiveness of treatment interventions will depend on their proper evaluation. Video recording of the gait can help with this, but observation is often the only way to assess it.

Computerized gait analysis is an objective, standardized, reproducible, and quantifiable method of gait analysis. Although gait analysis has been shown to influence decision making, there is little evidence that decisions based on this technique lead to better outcomes.

Computerized gait analysis is useful as a research and educational tool. Of course, this is additional help during clinical reasoning. However, this requires expensive high-tech equipment and trained personnel. Therefore, for most clinics, computerized analysis will be only an elective and not part of a routine clinical examination.

Diagnostics

Clinical assessment of the neurological status reveals pathological muscular dystonia, a decrease in the volume of voluntary motor activity on half of the body. If total paresis is detected, a double form of damage is diagnosed. At an appointment with a neurologist, the state of mental development and the level of cognitive skills are examined. To confirm the diagnosis, instrumental and laboratory methods are used:

• Neuroimaging. In children of the first year of life, neurosonography is prescribed to study the substance of the brain; in older children, CT or MRI is mainly used. Neuroimaging helps to determine a possible organic defect of cerebral tissue, which became the immediate root cause of the disease, including bilateral disorders in the double (tetraplegic) variant of the pathology.
• Electrophysiological methods. EEG is recommended in all cases of cerebral palsy accompanied by epileptic seizures. For a detailed study of the state of muscles and neuromuscular transmission, electromyography and electroneurography are performed.
• Analyzes. For hemiplegia and signs of stroke, MRI shows an extensive study of blood coagulation parameters. To exclude hereditary metabolic diseases that may occur with a similar clinical picture, the results of biochemical tests and genetic studies are indicative.

Treatment of spastic hemiplegia

The therapeutic approach is based on adherence to the principles of complex multidisciplinary treatment, which involves a team of specialists: neurologists, psychologists, speech pathologists, kinesiotherapists. Given the numerous complications of cerebral palsy, patients require the help of an orthopedist, otolaryngologist, and ophthalmologist. The most difficult is the treatment of double paralysis. The following areas of therapy are distinguished:

• Non-drug methods. Diet therapy is prescribed to correct energy deficiency and malnutrition, and vitamin and mineral complexes are selected according to indications. To improve mobility and normalize muscle tone, special kinesiotherapy programs and therapeutic massage courses are carried out.
• Drug therapy. In the spastic form of paralysis, a good effect is observed from taking oral muscle relaxants, GABA derivatives, and benzodiazepine tranquilizers. To relieve local spasticity, botulinum therapy is performed.
• Orthopedic correction. To ensure independent movement, individually selected orthoses are recommended. Double hemiplegia requires the use of multifunctional wheelchairs and special beds. Atlant and Gravistat suits are used for dynamic proprioceptive correction of posture.
• Defectological correction. An individual training program is prescribed to stimulate the patient’s mental development, increase his social adaptation, and develop ways to compensate for existing impairments (deafness, blindness).
• Alternative methods. Acupuncture, acupuncture, manual therapy and osteopathy are practiced as adjuvant therapy. In some cases, a positive effect is observed during dolphin therapy and hippotherapy.

Types of hemianopsia

Pathology, depending on which part of the eye blindness occurs, can be divided into several types.

Homonymous. It, in turn, distinguishes the following subspecies:

• right-sided;
• left-handed;
• contralateral;
• square.

Heteronymous. These include:

• bitemporal;
• binasal.

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Homonymous: right-handed and left-handed

With this type of disturbance in the perception of the world, the patient sees only one half of the image field. The line between the part of the picture visible to a person and what is considered a blind spot is located vertically exactly in the center. Pathology can arise either due to disorders in the occipital lobe of the cerebral cortex, or due to damage to the visual pathways.

With contralateral hemianopia, the patient does not see anything that is in the area of ​​the nose of one eye and the temporal part of the other.

Right-sided hemianopsia is presented as a distortion of the perception of the world in the right parts of the left and right eyes. Left-sided - characterized as a visual impairment in which the left side of both eyes is considered the dead zone.

With the square variety, there is loss of the image of only a quarter of the right and left eyes.

Preventive therapy – eye drops to improve vision.

Heteronymous: bitemporal and binasal

This pathology manifests itself in the occurrence of blindness in the nasal or temporal parts. The line separating the non-perceiving part from the visible part is horizontally located exactly in the middle.

In bitemporal hemianopia, the blind spot is considered to be the lateral field of vision from both the right and left eyes. To be more precise, the picture disappears in the temple area.

With binasal hemianopia, the patient cannot see with both eyes what is located in the nose area.

Restorative therapy for cataracts – Potassium iodide eye drops.

Prognosis and prevention

An integrated approach to the treatment of unilateral spastic hemiparesis shows good results in compensating for neurological deficits and socializing patients, but double hemiplegia has an unfavorable prognosis. Prevention of pathology consists of proper preparation and management of pregnancy, prevention of obstetric injuries, and regular monitoring of the baby by a pediatrician to monitor physical and mental development.

You can share your medical history, what helped you in the treatment of spastic hemiplegia.