If hemiplegia for the left or right side of the body, different body parts can be touched together or not: the arm and / or leg and / or sometimes the face.
Hemiplegia is caused by damage to central nervous system (brain and spinal cord): the execution orders of movements are not transmitted to the muscles. In addition to motor problems, other functions can be altered as memory or sensitivity.
Injury to the nerve pathway that provides control of the muscles may occur on different occasions.
The most common cause is stroke (CVA). Stroke can have different origins: the interruption of irrigation of part of the brain caused by a clot that blocks an artery or cerebral hemorrhage. They result in oxygen deprivation in a given area, in this case where the nerve cells die.
Hemiplegia is set up very quickly but sometimes regresses more or less disabling sequelae.
Trauma can also cause hemiplegia brutal and immediate.
Hemiplegia which occur more gradually they are caused by brain tumors, infections (encephalitis and brain abscess).
Hemiplegia caused by a lesion of the pyramidal tract. This is the main neural pathway that carries the motor orders. It is therefore a set of neurons involved in voluntary movement.
The pyramidal pathway begins in the brain at an area of nerve cells of pyramidal shape and joined with other nerve cells of the spinal cord. Pyramidal tract neurons then transmit their orders to LMN which carry them to the muscles. Before reaching the spinal cord, brain stem, the pyramidal tract changes sides. This explains that a lesion is localized on the side opposite the affected limb: left brain injury causes a right hemiplegia and vice versa.
Observed with different depending on the location of the injury.
A brainstem lesion, it causes a paralysis of one side of the body and involvement of the face on the other side.
In some cases the lesions, arm and leg are affected, in others only the arm or only the face.
When hemiplegia is partial and that movements are still possible, there is a decrease in muscle strength and mobility impaired, as manifested by clumsiness, trouble walking accompanied by a great tiredness and falls of one side.
When hemiplegia is total, even lesreflexes are abolished. However, the Babinski sign is present: when you touch the outside of the foot, it causes an extension of the big toe. In a healthy person, this stimulation leads to a bending of the big toe.
Hemiplegia is accompanied by changes in muscle tone: the muscles are stiff and overly contracted any (spastic hemiplegia) or conversely soft and flabby (flaccid hemiplegia).
On the face, the damage to the muscles can result in a drooping eyelid or an asymmetric smile.
In addition to motor disturbances, hemiplegia is characterized by the appearance of other symptoms.
The immobility of paralysis arising Member is responsible for complications that specialists in physical medicine and rehabilitation at trying to prevent the initial management.
The main complication remains on the loss of autonomy: everything must be done to try to recover mobility as complete as possible.
Among the complications that can occur after hemiplegia
Moreover, the bones of people with hemiplegia are weakened and lose bone density (osteopenia) as the brain give rise to abnormal vascularization of bone.
Finally, sitting in a wheelchair or bedridden status may promote pressure sores (skin necrosis at the points of support) and problems such as venous disorders of venous circulation, the risk of phlebitis and edema.
The sphincter disturbances can cause infectious complications.
Faced with a hemiplegic patient, the doctor performs a neurological exam to assess the extent of the invasion.
It tests the presence of a Babinski sign by stimulating the outer edge of the sole from the heel to midfoot: if the person suffers from hemiplegia, the great toe by an extension, which is indicative a lesion of the pyramidal pathway.
There are situations where the diagnosis is not obvious because the hemiplegia may present with subtle signs such as clumsiness or fatigability of muscles on one side of the body. So the doctor performs a series of examinations, and in particular the operation of Barre highlighting deficits on one leg or one arm or both. In the case of an unconscious person, the hemiplegia was found from different specific maneuvers.
Imaging studies, CT or magnetic resonance imaging (MRI) can detect the causes (aneurysm, tumor embolism, …) cause brain damage.
An electro encephalogram may give information about brain injury and their importance.
A neuropsychological examination can identify possible cognitive impairment such as aphasia, common in cases of hemiplegia.
The treatments are based upon that of the cause to prevent worsening of the hemiplegia, see the roll back.
Depending on whether a thrombosis (a clot blocking an artery) or hemorrhage treatment will be suitable but the urgency is the same.
The initial management is performed in a specialized, neurovascular emergencies. Hemiplegia can be immediately serious respiratory complications, or even respiratory arrest indicating a breakdown asistée.
Then, the main treatment of hemiplegia is rehabilitation, as early as possible to allow the recovery of certain deficiencies and prevent the occurrence of complications. This will complete rehabilitation, physical and cognitive, sensory, but also if necessary.
Beyond physiotherapeutic care can involve a speech in the presence of speech, if there is an orthoptist oculiares disorders can be reeducated, an occupational therapist to find all the aid which may facilitate the actions of everyday life and promote the maintenance home in case of loss of autonomy.
The management of hemiplegia is a service that specializes in physical medicine and rehabilitation (PMR) by a multidisciplinary team. His goal: to ensure greater independence and find walking possible with physical therapy and improve communication through speech therapy. Several rehabilitation methods (Bobath, Kabat, Schepherd and Carr) can be put to work.
Occupational therapy can learn to perform everyday activities. Finally, psychological treatment is recommended since depression is very common in people with hemiplegia.
Neurology is a specialty devoted to the study of anatomy and functioning of the central nervous system (brain and spinal cord) or peripheral (nerves and roots) and treatment of diseases that can touch it. The neurological diagnosis is based on a careful history and examination of different reflexes and nervous system functions. It also calls for further investigations: imaging (MRI or CT), electroencephalogram (EEG), Electroneuromyography (EMG), lumbar puncture, neuropsychological tests.
Neurology supports the movement disorders – paralysis of cerebral origin or related to a spinal cord or peripheral nerves, or to a muscle disease (myopathy), movement disorders (tremors, tics, such as torticollis ), cramps – and sensitivity: tingling, numbness, insensibility, some balance problems but also neuralgic pains, migraines, headaches.
Epilepsy, disorders of consciousness and sleep disorders (insomnia, mental confusion) and disruption of brain function (memory, language, comprehension, drawing, calculating, reasoning …) are also the responsibility of the neurologist.
General medicine, which has been recognized as a specialty in 2009, provides specific functions: overall management of the patient, continuity and coordination of care.
The GP is, because of its proximity and specific exercise field, the center of care networks. He is a partner of public health activities: prevention, screening, health and social education. Its role is essential in coordinating the care of older people and people in precarious situations.
Increasingly, GPs working in group practices or multidisciplinary medical centers, thereby widening the scope of expertise available to patients and increase the range of consulting hours.
This is the general practitioner who is most often declared as physician to Social Security. But every physician, whatever his specialty may be selected in this role.