Hemiplegia
The content of the article:
- Causes
- Kinds
- Signs
- Diagnostics
- Treatment
- Consequences and complications
Hemiplegia is a neurological syndrome characterized by a complete lack of motor activity of the upper and lower extremities of the right or left side, often with the involvement of the muscles of the trunk and face on the affected side.
Close in meaning to the term "plegia" is the term "paresis", which also denotes a movement disorder, but not complete, but partial.
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Causes
The anatomical substrate for the development of hemiplegia is a lesion at various levels of the pyramidal pathway, along which the transmission of nerve impulses is carried out in the upper-lower direction: from the cells of the cerebral cortex through its structures to motor neurons (motor nerve cells) located in the anterior horns of the spinal cord.
In the lower part (caudal, or caudal) of the medulla oblongata, the fibers of the pyramidal tract make a partial intersection, therefore, as a rule, damage to the left half of the body indicates damage to the structures of the right hemisphere (and vice versa, if the damage is located below the intersection, hemiplegia is determined on the side of the injury).
Physiological blockade or destruction of motor neurons of the anterior horns or their axons in the anterior roots of the spinal cord and spinal nerves also lead to the development of hemiplegia.
Causal factors of motor neuron damage:
- hemorrhage in the tissue of the brain or spinal cord;
- ischemia of the tissues of the brain or spinal cord due to thrombosis and embolism of the blood vessels supplying them;
- traumatic brain injury;
- spinal cord injury;
- neuroinfection;
- endo- and exogenous intoxication;
- hereditary diseases leading to demyelination of nerve fibers;
- parasitic diseases with damage to the spinal cord or brain;
- volumetric neoplasms;
- mental illness (functional hysterical hemiplegia).
Kinds
According to the etiological factor, hemiplegia is:
- organic;
- functional.
By the type of the affected motor neuron:
- central (spastic);
- peripheral (lethargic).
By the location of the muscles involved:
- right-sided;
- left-sided.
Depending on the location relative to the lesion focus:
- contralateral (for central lesions, on the opposite side);
- homolateral (with peripheral lesions, on the side of the focus);
- double.
Lesions with hemiplegia
By the level of defeat:
- cortical (with damage to the motor area of the cerebral cortex);
- supracapsular (the focus is located closer to the inner capsule);
- cortical-subcortical;
- pyramidal-thalamic (in the area of the visual hillock);
- capsular;
- alternating (cranial nerves suffer on the side of the lesion, and hemiplegia develops on the opposite);
- alternating optic-pyramidal (one-sided blindness on the side of the lesion and hemiplegia on the opposite side);
- cross (at the intersection of the fibers of the tract);
- spinal (there is no damage to the cranial nerves).
Depending on the stage of the pathological process:
- diaschisal (occurs in the acute period of coma due to shock changes in the centers of the brain);
- progressive (with a prolonged, increasing course of the underlying disease);
- regressive (with clinical improvement).
Signs
Central hemiplegia symptoms:
- complete absence of active movements in the affected limbs, facial muscles on the side opposite to the lesion;
- spastic muscle hypertonia;
- a folding knife symptom (muscle resistance when trying to passively bend the patient's limb at the knee or elbow joints, after overcoming the initial resistance, flexion occurs without difficulty);
- increased tendon and periosteal reflexes in paralyzed limbs;
- decreased abdominal reflexes on the hemiplegia side;
- decrease in deep and superficial sensitivity;
- decreased articular reflexes (Leri, Mayer);
- pathological reflexes of the extremities (Babinsky, Gordon, Oppenheim, Schaeffer, extensor Redlich and Rossolimo, Bekhterev - Mendel, Zhukovsky, etc.);
- identification of reflexes of spinal automatism;
- friendly synkinesis (involuntary muscle contractions and movements accompanying an active motor act).
Gait options for hemiplegia
With peripheral hemiplegia, muscle tone is reduced (a combination of spastic changes in muscle tone with hypotension is possible), reflexes are also reduced on the affected side. In this case, mimic muscles are not involved in the pathological process.
Diagnostics
The main way to diagnose hemiplegia is to carry out characteristic neurological tests (Barre, Mingazzini, Garkin, Goffman, etc.), which make it possible to identify the nature of hemiplegia and carry out differential diagnostics with neurological diseases with similar symptoms.
Electromyography is the main type of instrumental diagnostics of hemiplegia
From instrumental methods, electromyography is used - in order to fix the bioelectric activity of muscles.
To reliably identify the focus of damage to the pyramidal tract, computed or magnetic resonance imaging is performed.
Treatment
In the complex therapy of hemiplegia, the following are used:
- drugs that improve metabolic and trophic processes in the nervous tissue;
- neuroprotective agents;
- muscle relaxants;
- antioxidants;
- cholinesterase inhibitors;
- physiotherapeutic effects (massage, electrophoresis, kinesitherapy, exercise therapy).
Physical therapy plays an important role in the treatment of hemiplegia
Consequences and complications
Depending on the location, the extent of the lesion and the severity of the underlying disease, hemiplegia can be reversible and regress without a trace or with minor residual effects or acquire a permanent, uncorrected character.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
