You are on page 1of 26


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 5th
.cervical segment

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

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

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

Traumatic: 6.Neoplastic: 4.Demyelinations: 5.2-Infective: 3.Hysterical: .Congenital: 7.

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

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



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

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

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

Spinal Cord-1 At the level of the lesion Pain&Te m Touch Deep sensation Below the level of lesion .

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

3.Cerebral 1.Cortical 2.Subcorical 3.Capsular .

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

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

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

B.Anti platelates: *Aspirin: single dose 75-300mg daily *Persantin:75 mg twice daily * Ticlopidine:250 mg twice daily .P is very low.d.P is above 200/120.Specific Treatment 1).s * Vasopressor drugs-----------if B.Cerebral Thrombosis: A-Care of Blood Pressure * Hypotensive drugs---------if B.4. Capotril--------25to50 t.

Anticoagulants: used in all cases Indications: Contraindications: .C.

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

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

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

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

Thank you .