Hemiplegia

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

Hemiplegia is a condition in which the limbs on one side of the body have severe weakness. Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked weakness. 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.

Causes

The most common cause of hemiplegia is a cerebrovascular accident, also known as a stroke. Strokes can cause a variety of movement disorders, depending on the location and severity of the lesion. Hemiplegia is common when the stroke affects the corticospinal tract. Other causes of hemiplegia include spinal cord injury, specifically Brown-Séquard syndrome, traumatic brain injury, or disease affecting the brain. As a lesion that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the Upper Motor Neuron Syndrome. Features other than weakness include decreased movement control, clonus (a series of involuntary rapid muscle contractions), spasticity, exaggerated deep tendon reflexes and decreased endurance.

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.

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. Weakness on one side of the face may occur and may be due to a viral infection, stroke or a cancer.

=== Medial medullary syndrome

Main article: medial medullary syndrome

Common causes by etiology

• Vascular: cerebral hemorrhage, stroke, diabetic neuropathy
• Infective: encephalitis, meningitis, brain abscess
• Neoplastic: glioma-meningioma
• Demyelination: disseminated sclerosis, lesions to the internal capsule
• Traumatic: cerebral lacerations, subdural hematoma rare cause of hemiplegia is due to local anaesthetic injections given intra-arterially rapidly, instead of given in a nerve branch.
• Congenital: cerebral palsy
• Disseminated: multiple sclerosis
• Psychological: parasomnia (nocturnal hemiplegia)

Pathogenesis

The exact cause of hemiplegia is not known in all cases, but it appears that the brain is deprived of oxygen and this results in the death of neurons. When the corticospinal tract is damaged, 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.

Signs and Symptoms

Hemiplegia means severe weakness of the limbs on one side of the body but the specific features can vary tremendously from person to person. Problems may include:

• Difficulty with gait
• Difficulty with balance while standing or walking
• Having difficulty with motor activities like holding, grasping or pinching
• Increasing stiffness of muscles
• Muscle spasms
• 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
• Behavior problems like anxiety, anger, irritability, lack of concentration or comprehension
• Emotions- depression

Diagnosis

Hemiplegia is identified by clinical examination by a health professional, such as a physiotherapist or doctor. Radiological studies like a CT scan or magnetic resonance imaging of the brain should be used to confirm injury in the brain and spinal cord, but alone cannot be used to identify movement disorders. Individuals who develop seizures may undergo tests to determine where the focus of excess electrical activity is.

Treatment

Treatment should be based on assessment by the relevant health professionals, including physiotherapists, doctors and occupational therapists. Muscles with severe motor impairment including weakness need these therapists to assist them with specific exercise, and are likely to require help to do this.

Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Drugs like Librium or Valium could be used as a relaxant. Drugs are also given to individuals whom have recurrent seizures, which may be a separate but related problem after brain injury.

Surgery may be used if the individual develops a secondary issue of contracture, from a severe imbalance of muscle activity. In such cases the surgeon may cut the ligaments and relieve joint contractures. Individuals who are unable to swallow may have a tube inserted into the stomach. This allows food to be given directly into the stomach. The food is in liquid form and instilled at low rates. Prosthetics. Some individuals with hemiplegia will benefit from some type of prosthetic device. There are many types of braces and splints available to stabilize a joint, assist with walking and keep the upper body erect.

Rehabilitation is the main treatment of individuals with hemiplegia. In all cases, the major aim of rehabilitation is to regain maximum function and quality of life. Both physical and occupational therapy can significantly improve the quality of life. Physical therapy can help improve muscle strength, mobility such as standing and walking, and other physical function. Occupational therapy may help the individual train 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.

Prognosis

Hemiplegia is not a progressive disorder, except in progressive conditions like a growing brain tumour. Once the injury has occurred, the symptoms should not worsen. However, because of lack of mobility, other complications can occur. Complications may include muscle and joint stiffness, loss of aerobic fitness, muscle spasms, bed sores, pressure ulcers and blood clots.

Sudden recovery from hemiplegia is very rare. Many of the individuals will have limited recovery, but the majority will improve from intensive, specialised rehabilitation. Potential to progress may differ in cerebral palsy, compared to adult acquired brain injury. 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.

Hemiplegia in popular culture

• In Barbara Kingsolver's novel, Poisonwood Bible, the character Adah is incorrectly diagnosed, in childhood, as having hemiplegia.

See also

• alternating hemiplegia
• hemiplegic migraine
• laryngeal paralysis
• Paraplegia
• spasticity

External links

• CHASA Children's Hemiplegia and Stroke Association non-profit organization
• HemiHelp, a UK based childhood hemiplegia (cerebral palsy) charity
• [1] Living with hemiplegia a child's perspective by Katy Roberts
• AHC Kids Dutch website about Alternating Hemiplegia of Childhood
• Spinal Cord Injury Peer Support
• Hemiplegia and associated problems
• Wrong Diagnosis.com General Hemiplegia Info, Tools & Discussion Boards

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