Recomendados
Más contenido relacionado
La actualidad más candente
La actualidad más candente (20)
Destacado
Destacado (14)
Similar a Hemiplegia
Similar a Hemiplegia (20)
Más de Daniel Augustine
Más de Daniel Augustine (20)
Último
Último (20)
Hemiplegia
- 2. History • Goals • 1. Etiology • 2.Localization
- 3. Etiology • Non – CVA – Neoplasm – Infection – Demyelination – Trauma (SDH) • CVA – Thrombosis – Embolism – Hemorrhage
- 4. Non- CVA • Onset- More gradual • Progression –gradual • Recovery • Fever - infection
- 5. CVA • Sudden onset • Progression • Recovery • Deficit explainable by a vascular territory lesion
- 6. CVA - Thrombosis • Most common • Slowest – Hours • Wakes up in the morning with weakness • History of TIA • Old age
- 7. Embolism • Fastest onset - Seconds • No progression {Max. deficit at onset} • History of heart disease • Younger age group • Major deficit ( heart to vessel )
- 8. Hemorrhage • H/o Prolonged hypertension • Awake – stress • Head ache • Vomiting • Altered consciousness • Convulsion
- 9. Localization • Internal capsule • Cortex • Subcortex - Corona radiata • Brainstem – Midbrain, Pons, Medulla • Spinal cord
- 10. Internal capsule • Dense&uniform hemiplegia ( UMN Facial ) • Hemisensory blunting • Homonymous Hemianopia
- 11. Cortex • Non dense nonuniform weakness • Monoplegias • Cortical signs – Dysphasia – Apraxia – Cortical ssensory loss – Convulsions
- 12. Subcortex • Pattern of weakness similar to cortical – Non dense non-uniform weakness • No cortical signs
- 13. Brainstem • Crossed hemiplegia • Ipsilateral LMN CN palsy & contralateral hemiplegia • Cerebellar signs
- 14. Points in history helping localization • Grade of weakness – dense or not • Uniformity of weakness – • UMN facial palsy - present or not • Cortical symptoms – Focal seizures;Dysphasia;Apraxia • Cranial nerve palsies, gaze palsies • Level of consciousness • Recovery
- 15. Clinical examination • General – Pulse, BP,LN,Clubbing.neurocutaneous markers • Other systems - CVS – Valvular heart disease,CAD,Hypertensive heart disease • NS
- 16. Neurological examination • Higher functions • Cranial nerves • Tone • Weakness – Grade,symmetry • Reflexes • Sensory – +Cortical • Cerabellar • Meningeal irritaion
- 17. Localization • Internal capsule • Cortex • Subcortex - Corona radiata • Brainstem – Midbrain, Pons, Medulla • Spinal cord
- 18. Internal capsule • Dense&uniform hemiplegia ( UMN Facial ) • Hemisensory blunting • Homonymous Hemianopia
- 19. Cortex • Non dense nonuniform weakness • Monoplegias • Cortical signs – Dysphasia – Apraxia – Cortical ssensory loss – Convulsions
- 20. Subcortex • Pattern of weakness similar to cortical – Non dense non-uniform weakness • No cortical signs
- 21. Brainstem • Crossed hemiplegia • Ipsilateral LMN CN palsy & contralateral hemiplegia • Cerebellar signs
- 22. Midbrain • crossed cerebellar ataxia with ipsilateral third nerve palsy (Claude's syndrome): • Weber's syndrome: third nerve palsy and contralateral hemiplegia: • Contralateral hemiplegia: Cerebral peduncle • Contralateral rhythmic, ataxic action tremor; rhythmic postural or "holding" tremor (rubral tremor):
- 23. Pons • LMN Facial + contralateral hemiplegia • +VI th Nerve + cotralateral hemiplegia • + Lateral Gaze palsy + cotralateral hemiplegia
- 24. Medulla – lateral Medullary syndrome • Same side – Horner’s syndrome – Loss of pain & touch on the face – Cerebellar signs – Palate weakness • Opposite side – Loss of pain and temperature sensation on the body and limbs
- 25. Medial Medullary syndrome • Same side • Wasting and weakness of the tongue • Opposite side • Hemiplegia without facial palsy
- 26. Spinal cord • Rare • No facial • Brown sequard Syndrome
- 27. Hemiparesis without Facial palsy • Cortex • Subcortex • Medial medulla • Spinal cord
- 28. Hemiparesis with cranial N palsy • Brain stem lesions – LMN CN palsy • UMN Facial palsy • Transient UMN weakness in the initial stages of Higher lesions – Palate. Jaw.Tongue
- 29. Hemiplegia & coma • Intra cerebral hemorrhage • Large infarctions • Brainstem lesions
- 30. Hemiplegia & coma Problems in examination • Higher functions - assess grade of coma • Cranial nerves – II- menace, light reflex – III, IV, VI - Doll’s eye – VII – bulge with breathing, NL fold, Pain effect – IX , X – Gag reflex • Motor system – Tone, Posture,(grab,lift &drop)Movement on pain • Sensory system- assessment not possible • Cerebelar – not possible
- 31. Hemiplegia & Aphasia Problems in examination • Higher functions – level of consciousness • Cranial nerves – II-Watch Gaze & Fixation, menace, light reflex – III, IV, VI – Watch eyemovements, Squint, ptosis – VII – Watch expressions, NL fold, Pain effect – IX , X – Nasal regurgitation, aspiration, Gag reflex • Motor system - Watch movements – Tone, Posture,(grab,lift &drop)Movement on pain • Sensory system- assess pain • Cerebelar– Watch coordination, Gait, Intention tremour,
- 32. When not sure, What? • Localization – Internal capsule • Vessel - Middle cerebral • Cause - Thrombosis
- 33. Commonly asked questions • Etiology? • Localization? • Investigations? • Treatment? • Demonstrate – Tone, Power, Neck stiffness, Kernig’s, Plantar, DTR, Cerebellar, Clonus
- 34. Commonly forgotten points • Proper examination of CVS • Careful GE • Meningeal signs • Skull & Spine • Carotid Bruit • Case sheet - write Diagnosis properly
- 35. THE END