Approach to hemiplegia
-
Upload
dr-sudhir-kumar -
Category
Health & Medicine
-
view
280 -
download
1
Transcript of Approach to hemiplegia
APPROACH TO HEMIPLEGIA
DR SUDHIR KUMAR MD DM (NEUROLOGY)SENIOR CONSULTANT NEUROLOGIST
APOLLO HOSPITALS, HYDERABAD
OVERVIEW• Brain stroke is the commonest cause of hemiplegia,• Stroke is among the three most common causes of death
and disability (heart attack and cancer are the other two),• It is important to correctly and quickly diagnose stroke, as
treatment (thrombolysis) is time-bound,• Missed or delayed diagnosis can deny thrombolytic
therapy,• On the other hand, thrombolysis of a “stroke-mimic” may
be harmful• We look at some of the common stroke mimics, which can
present with acute onset hemiplegia
CASE 1 • 60-year old man,• One hour duration of drowsiness, headache
and vomiting,• BP: 220/110 mmHg• Left-sided weakness
CT BRAIN
DIAGNOSIS• Brain hemorrhage• Contraindication to thrombolysis,• About one-third of all strokes,• Management includes control of BP and
lowering of ICP (mannitol, mechanical ventilation); surgery in some cases.
CASE 2• 55-year old lady,• Known diabetic,• Right hemiplegia of 45 minutes duration• On admission, power grade 0/5 in right UL, LL• CT brain- normal• 30 min later, complete recovery. Power-grade
5/5 all 4 limbs
DIAGNOSIS• TIA- transient ischemic attack• No need to thrombolyse in cases of TIA• However, if the recovery is incomplete,
thrombolysis should be considered• All patients with TIA should be started on anti-
platelets and statins, as they have a high risk of stroke in future, esp in the first 30 days after TIA.
CASE 3• 70-year old man,• Sudden onset left hemiplegia of two hours
duration,• History of fall at home present,• Mild drowsiness, power grade 3/5 left UL, LL
CT BRAIN
DIAGNOSIS• Acute subdural hematoma (SDH)• Treatment is urgent surgery- Burr hole
evacuation of hematoma.
CASE 4• 25-year old lady,• Acute onset weakness of right side of body of
three hours duration,• Preceded by headache for three days,• One episode of seizure while in ER,• Drowsy, arousable, obeys a few commands• Power grade 3/5 right UL, LL
CT BRAIN
DIAGNOSIS• CVST (Cerebral venous sinus thrombosis)• Common in post-partum period, after OCP
use, head injury, thrombogenic states such as nephrotic syndrome, malignancy, protein C/S deficiency
• Confirm by MRI/MRV brain• Treatment- anticoagulation with heparin• Intra-sinus thrombolysis in selected cases.
CASE 5• 21-year old man presented with weakness of
right arm and leg of three hours duration,• He had a GTCS at the onset of weakness,• He had history of epilepsy in childhood, and
was treated with valproate for three years.• Conscious, alert, power grade 3/5 in right UL,
LL
CT BRAIN• CT brain- normal• Diagnosis- Todd’s paresis• Todd’s paralysis can last from 30 min to 36
hours (average duration is 15 hours)• Resolves on own and no treatment is
necessary.
CASE 6• 55-year old lady,• Known diabetic on metformin and glimepiride,• Brought to ER with sudden onset left
hemiplegia and drowsiness of one hour duration
• Drowsy, not obeying commands, left hemiplegia,
• CT brain- normal
• RBS- 30 mg%• Diagnosis- hypoglycemic hemiparesis• Hemiparesis occurs in 4.2% cases of
hypoglycemia, at an average glucose of 32 mg% or less,
• Mostly right hemiparesis (in 66% of cases)• Internal capsule or splenium of corpus
callosum lesion may be seen on MRI brain,• Rapidly improves with dextrose infusion
CASE 7• 19-year old girl• Presented with acute onset right hemiplegia
and aphasia of two hours duration,• History of fever and cough two weeks ago,
subsided in 3 days on own
MRI Brain
DIAGNOSIS• Acute disseminated encephalo-myelitis
(ADEM)• An auto-immune condition, affecting white
matter of brain,• Treated with IV methylprednisolone for 3-5
days• Good recovery is seen.
OTHER CAUSES of hemiplegia
• Hyperglycemia,• Hyponatremia,• Brain tumor with bleed,• Brain abscess,• Encephalitis, meningitis
COMMENTS/QUERIESWhatsapp: 9866193953
Email: [email protected]
Facebook: www.facebook.com/bestneurologist/