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Hemiplegia is total paralysis of the arm, leg, and trunk on the same side of the body.Hemiplegia is more severe than hemiparesis, wherein one half of the body has less

marked weakness.[1]

Hemiplegia may be congenital or acquired from an illness orstroke.

Hemiplegia is not an uncommon medical disorder. In elderly individuals, strokes are

the most common cause of hemiplegia. In children, the majority of cases ofhemiplegia 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.[2]

] 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, specificallyBrown-Squard syndrome, traumatic brain injury, or disease affecting thebrain. 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 duringpregnancy and

experts believe that this may be related to either a traumatic delivery, use offorceps or

some event which causes brain injury.[3]

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.[4]

[edit] Medial medullary syndrome

Main article: medial medullary syndrome

[edit] Common causes by etiology

y Vascular

:

cerebral hemorrhage,

[5]

stroke, diabetic neuropathyy Infective:encephalitis, meningitis,brain abscessy Neoplastic:glioma-meningiomay Demyelination:disseminated sclerosis, lesions to the internal capsuley Traumatic: cerebral lacerations, subdural hematoma rare cause of hemiplegia

is due to local anaesthetic injections given intra-arterially rapidly, instead ofgiven in a nerve branch.

y Congenital: cerebral palsyy Disseminated:multiple sclerosis

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y Psychological :parasomnia (nocturnal hemiplegia)[6]

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 mayinclude:

y Difficulty with gaity Difficulty with balance while standing or walkingy Having difficulty with motoractivities like holding, grasping or pinchingy Increasing stiffness of musclesy Muscle spasmsy Difficulty with speechy Difficulty swallowing foody Significant delay in achieving developmental milestones like standing,

smiling, crawling or speaking

y The majority of children who develop hemiplegia also have abnormal mentaldevelopmenty Behavior problems like anxiety, anger, irritability, lack of concentration or

comprehension

y Emotions- depression

[edit] Diagnosis

Hemiplegia is identified by clinical examination by a health professional, such as a

physiotherapist or doctor. Radiological studies like a CT scan ormagnetic 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.[7]

Hemiplegia patients usually show a characteristic gait. The leg on the affected side is

extended and internally rotated and is swung in a wide, lateral arc rather than lifted in

order to move it forward. The upper limb on the same side is also adducted at the

shoulder, flexed at the elbow, and pronated at the wrist with the thumb tucked into the

palm and the fingers curled around it.[8]

[edit] Treatment

Treatment should be based on assessment by the relevant health professionals,includingphysiotherapists, 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.[9]

Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Drugs

like Librium orValium could be used as a relaxant. Drugs are also given to

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individuals whom have recurrent seizures, which may be a separate but relatedproblem afterbrain injury.[10]

Surgery may be used if the individual develops a secondary issue ofcontracture, 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 thestomach. The food is in liquid form and instilled at low rates. Prosthetics. Some

individuals with hemiplegia will benefit from some type ofprosthetic 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 bedone at home and become part of daily life routine.

[11]

Risk factors:

y Agey High blood pressure weakens the walls of arteriesy Atherosclerosis narrowed artery channelsy Heart disease cause blot clot in the heart that may break off and migrate to

the brain.

y Diabetes mellitus accelerated degeneration of small blood vessely Smoking increase the risk ofhypertensiony Polycythemia a raised level of red cells in the blood.y Hyperlipidemia high level of fatty substances in the blood