hemiplegia دكتور عزوني

⚜ Case: A young girl , her father complains that she was very polite and wise then suddenly
she became
shameless and extravert, after 1 & half months she started to have dysphasia &drop of some words in while
speaking , she seeked neurologist, by examination she had emotional numbing , dysphasia, the neurologist
said that she have organic lesion in frontoparatemporal region, because speech center are present front-
temporal area & he told them to do MRI, After doing MRI , She diagnosed by having "Brain tumor", so (
Organic lesion could be presented by psychiatric Manifestations ).
(Hemi= half , Plegia=paralysis)
(v.i.p.)
U.M.Neurons (1ry motor area 4 ,premotor area 6) in frontal & temporal lobes nerve fibers will pass to ➡ Corona
radiata (subcortix) ➡ then to Internal Capsule ➡ thin to Midbrain ➡ thin to Pons ➡ thin to Medulla ( here
Decussation happens ). So, lesion in left frontal lobe will cause Right sided hemiplegia (contralateral hemiplegia).
✴ Developmental (Intrauterine life), (Archinoid cyst in brain witch will cause lack of brain formation &
cause compression on pyramidal tract causing Hemiplegia).
✴ Traumatic {car accidents, head Trauma, spine Trauma, fracture spine, large Subdural hematoma,
depressed fructure of skull , birth trauma (ventose: witch will cause cephalohematoma & Intracranial Hemorrhage
witch compresses the midline structures causing Hemiplegia), Narrow pelvis in female}.
✴ Inflammatory (meningitis, encephalitis, meningioencephalitis).
✴ Neoplastic (meningioma).
✴ Vascular (most important): -
� Intracerebral Hemorrhage
� Intracerebral Infarction.
✴ Cortical: patient is (Monoplagic, Aphasic, Disturbed conscious level, Fits, hemihypoesthesia, up to

coma).(MCQ)
✴ Subcortical (weakness in upper & lower limb, but upper > lower).
✴ Capsular (Diffuse complete hemiplegia with equal effect on upper &lower limbs, hemi hypoesthesia,
homonyms hemianopia & there maybe Auditory weakness in both side but not always present).
✴ Brainstem {crossed Hemiplegia (v.v.i.p) (epsilateral cranial nerve palsy & contralateral Hemiplegia),
(Midbrain: 3,4 cranial nerves, Pons: 5,6,7,8 cranial nerves, Medulla: 9,10,11,12 cranial nerves & if there is
medullary syndrome: 9,10,11,12 cranial nerves are vasomotor cranial nerves ,so patient will complain of : vertigo ,
unsteadiness, vomiting, Ataxia, hemisweating }.
✴ Spinal.
1
✴ Laboratory: (CBC, LFT, KFT, Bl.lipids, Bl.Sugar).
✴ Radiological: (CT brain, MRI brain).
✴ Electrophysiological: (EEG).
✴ Histopathological: (Steriotactic biopsy under local anesthesia), like brain tumor patient.
✴ Miscellaneous.
✴ Treatment of the Cause.
{Any focal neurological deficit caused by cerebrovascular hemorrhage or infarction}.
(MCQ)
✴ Diabetes.
✴ Hypertension.
✴ Heart diseases (especially IHD).
✴ Cigarette Smoking (especially in young age).
✴ Dyslipidemia, Hypertriglyceridemia, High serum Uric acid.
✴ Cerebral Thrombosis:
� Cerebral atherosclerosis.
� Myocardial infarction.
� Occlusive blood diseases (Thalassemia, Polycythemia, Polycythemia rubra vera (RBCs

>16000/mm3, which causes hyperviscosity & hypcoagulability leading to vasooclusion).
✴ Cerebral Embolism.
2
(v.v.v.i.p)
✴ Blood diseases: (Hemorrhagic blood diseases).
✴ Hemophilia.
✴ Protein C&S deficiency.
✴ Migraine (especially girls in young age).
✴ Cigarette smoking.
✴ OCPS (most important) {contraindicated after age of 30}.
✴ Hypertension (less extent).
✴ Acute Major Stress.
{Focal weakness in one side of the body according to the extension of infarction and the type of vessel occluded}:
✴ Anterior cerebral Artery Occlusion (heaviness in his legs).
✴ Middle cerebral Artery Occlusion (Severe weakness in Contralateral side (contralateral dense
Hemiplegia), hemi hypoesthesia, aphasia in dominant hemisphere affection, (acute major stress may cause
this situation).
✴ Posterior cerebral Artery Occlusion (Blindness), due to Infarction in visual cortex.
✴ Laboratory: (CBC, LFT, KFT, Blood lipids, Blood Sugar).
✴ Radiological: (CT brain, MRI brain).
✴ Electrophysiological: (EEG).
3
(v.v.v.v.i.p)
✴ History taking while doing examination & Blood sampling for (Blood Sugar, Urea, Creatinine, blood
gases), ECG, plain X-Ray chest.
✴ Heart examination, blood pressure, pulse, temperature.
✴ If the patient came before 3-6 hours of onset of infarction (v.v.v.i.p):-
� Give rTPA (Recombinant tissue plasminogen activator) 0.9 mg/kg ✖ 500 cc normal saline patient
health state may improve in 4 hours.
✴ If the patient came in the 2nd day of the onset of infarction:
� Admission to ICU, Give antiplatelet (Aspirin), control blood pressure.
N.B: The ideal Therapeutic Window of rTPA injection in acute Ischemic Stroke is in “The first 3 hours”. (MCQ)
✴ Thrombotic: ✴ Embolic:
� Onset: Stroke in evolution in first 24 hours. � Onset: Sudden, Dramatic.
� Risk factors (Atherosclerosis, Diabetes, and � Source of Emboli must be present: (Rheumatic
Hypertension) Heart, Atrial fibrillation, double mitral, Mitral
stenosis, DVT).

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⚜ Case: A young girl , her father complains that she was very polite and wise then suddenly

(Hemi= half , Plegia=paralysis)

✴ Inflammatory (meningitis, encephalitis, meningioencephalitis).

✴ Vascular (most important): -

✴ Cortical: patient is (Monoplagic, Aphasic, Disturbed conscious level, Fits, hemihypoesthesia, up to

✴ Radiological: (CT brain, MRI brain).

✴ Treatment of the Cause.

{Any focal neurological deficit caused by cerebrovascular hemorrhage or infarction}.

✴ Heart diseases (especially IHD).

✴ Cigarette Smoking (especially in young age).

✴ Dyslipidemia, Hypertriglyceridemia, High serum Uric acid.

� Occlusive blood diseases (Thalassemia, Polycythemia, Polycythemia rubra vera (RBCs

✴ Blood diseases: (Hemorrhagic blood diseases).

✴ Protein C&S deficiency.

✴ Migraine (especially girls in young age).

✴ OCPS (most important) {contraindicated after age of 30}.

✴ Hypertension (less extent).

✴ Acute Major Stress.

✴ Anterior cerebral Artery Occlusion (heaviness in his legs).

✴ Posterior cerebral Artery Occlusion (Blindness), due to Infarction in visual cortex.

✴ Laboratory: (CBC, LFT, KFT, Blood lipids, Blood Sugar).

✴ Radiological: (CT brain, MRI brain).

✴ Heart examination, blood pressure, pulse, temperature.

✴ If the patient came before 3-6 hours of onset of infarction (v.v.v.i.p):-

✴ If the patient came in the 2nd day of the onset of infarction:

� Admission to ICU, Give antiplatelet (Aspirin), control blood pressure.

� Onset: Stroke in evolution in first 24 hours. � Onset: Sudden, Dramatic.

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