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Hemiplegia Dr. Shamekh M. El- Shamy. Hemiplegia Definition: paralysis of one side of the body due to pyramidal tract lesion at any point from its origin.

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Presentation on theme: "Hemiplegia Dr. Shamekh M. El- Shamy. Hemiplegia Definition: paralysis of one side of the body due to pyramidal tract lesion at any point from its origin."— Presentation transcript:

1 Hemiplegia Dr. Shamekh M. El- Shamy

2 Hemiplegia 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 5 th cervical segment.

3 Causes :- 1-Vascular causes:- A)-Thrombotic :- 1-Vessels wall diseases. 2-Blood diseases. 3-Circulation diseases.

4 B) - Embolic : The source of embolus may be:- 1- Heart 2-Distal vessels 3-Rare sources:. *Lung *Bones C)- Haemorrhagic: 1-Intracerebral 2-Subarachnoid 3-Subdural or extradural

5 The causes of intracranial haemorrhage are: 1-Hypertension: 2-Rupture of an intracranial aneurysm angioma 3- Haemorrhagic blood diseases 4-Trauma to the head:

6 2-Infective: 3- Neoplastic: 4- Demyelinations: 5- Traumatic: 6- Congenital: 7- Hysterical:

7 CLINICAL PICTURE Onset & Course: -Acute onset & regressive course (vascular, infective & traumatic lesions). -Gradual onset & progressive course (neoplastic lesions). -Remittent & relapsing course (D.S.).

8 Symptoms & Signs 1-Acute lesions: the clinical picture passes through 2 stages: A)-Stage of flaccidity: due to neuronal shock. B)-Stage of spasticity: this is the stage of established hemiplegia. 2-Gradual lesions: the hemiplegia passes directly to the stage of spasticity.

9 – STAGE OF FLACCID PARALYSIS (SHOCK STAGE): -

10 . STAGE OF SPASTTC. PARALYSIS: 1-Paralysis of one sideof the body.

11 2-Hypertonia (spasticity) of the paralysed muscles of clasp-knife type : 3-Exaggerated deep reflexes

12 4-Lost superficial reflexes: 5-Positive Babinski sign: 6-Gait :

13 According to the site of the lesion 1-Spinal 3-Cerebral 2-Brain stem

14 1-Spinal Cord At the level of the lesion Below the level of lesion Deep sensationPain&Tem Touch

15 2-Brain stem 1-Mid-brain lesion Weber Benedict M.L.B Millard-Gubler 2-Pontine lesions 3-Medullary lesions

16 3- Cerebral 1- Cortical 2- Subcorical 3- Capsular

17 MANAGEMENT OF HEMIPLEGIA 1-GENERAL:. Care of the skin:. Care of respiration:.Care of nutrition and fluid balance:.Care of the urinary bladder:. Care of the bowels:

18 Symptomatic Treatment 1.Cerebral dehydrating 2.Antiemetics 3.Tranquilizers and sedatives 4.Muscle relaxents 5.Vitamins and tonics.

19 3- Physiotherapy 1- Proper positioning of the hemipegic side. 2-Passive,active assited,active exercises.. To minimize contractures. To strength muscles 3-Antispastic methods to control spasticity. 4-Gait and balance training.

20 4- Specific Treatment 1)- Cerebral Thrombosis: A-Care of Blood Pressure * Hypotensive drugs if B.P is above 200/120. Capotril to50 t.d.s * Vasopressor drugs if B.P is very low. B- Anti platelates: *Aspirin: single dose mg daily *Persantin:75 mg twice daily * Ticlopidine:250 mg twice daily

21 C- Anticoagulants: used in all cases Indications: Contraindications:

22 Method : * Heparin * Dindivan or Marcoumar: anticoagulants. - Monitor the dose using the prothrombin time. * Antidote :-

23 D- Other drugs may be used: 1- Nootropil : 2- Trental : 3- Trivastal : 4- Cerebral Vasodilators :

24 B-Cerebral Embolism : c- Cerebral Haemorrhage : D- Cerebral Inflammation:

25 E- Brain Tumors : 1- Surgical removal. 2- Deep X-rays therapy.

26 Thank you


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