hemiplegia
Introduction
Introduction to hemiplegia Hemiplegia, also called hemiplegia, refers to the movement disorder of the upper and lower limbs, the facial muscles and the lower part of the tongue. It is a common symptom of acute cerebrovascular disease. Although mild hemiplegia patients can still move, but when they walk, they tend to flex their upper limbs, straighten their lower limbs, and take a half circle in the lower limbs. This special walking posture is called hemiplegic gait. Severe cases are often bedridden and lose their ability to live. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: inflammation around the shoulder joint muscle atrophy
Cause
Hemiplegia
Cerebral hemisphere cortical motor center damage (20%):
The cause of acute cerebrovascular disease is mainly due to the damage of the cerebral hemisphere cortex motor center. In terms of human brain hemisphere division, the right cerebral hemisphere manages the left limb movement through the motion center; the left cerebral hemisphere manages the right limb movement through the motor nerve. A lesion on either side can cause a contralateral hemiplegia.
Atherosclerosis (15%):
Atherosclerosis is the main cause of stroke. 70% of stroke patients have arteriosclerosis, and hyperlipidemia is one of the main causes of arteriosclerosis.
High blood pressure (15%):
Hypertension is the most common and most common form of stroke, and 93% of patients with cerebral hemorrhage have a history of hypertension.
Congenital abnormalities of cerebrovascular (20%):
Congenital abnormalities of cerebrovascular disease are a common cause of subarachnoid hemorrhage and cerebral hemorrhage.
Heart disease (10%):
Such as: endocarditis, there may be a wall thrombus; bradycardia may cause insufficient blood supply to the brain.
The causes of hemiplegia are diverse and complex. In general, they are inseparable from diseases such as increased blood lipids and increased blood viscosity. The following are summarized:
Causes of stroke: The pathogenesis of hemiplegia is acute and sudden, but the pathological process is mostly slow. In this pathological change, the predisposing factors of stroke cause this change to suddenly escalate, and a stroke, a general cause of stroke Have:
1. Poor mood (angry, excited).
2, diet is not good (overeating, improper drinking).
3, overworked, excessive force; excessive exercise; suddenly sit up and get up and other posture changes.
4, climate change, pregnancy, dry stools, watching TV for too long, using the brain improperly.
5, various disease factors, such as diabetes, high blood pressure, high blood lipids, hemophilia, heart disease, high blood viscosity, bradycardia, hardening of the arteries.
6, improper medication, such as the use of antihypertensive drugs.
Any cause of brain damage can cause hemiplegia, which is the most common cause of hemiplegia. Hemiplegia can occur in craniocerebral trauma, cerebral vascular malformations, cerebral aneurysms, brain tumors, intracerebral infections, brain degeneration and demyelinating diseases.
Prevention
Hemiplegia prevention
1. Regular physical examination is an important measure to prevent stroke and hemiplegia. There are many patients with strokes, and family members often feel very surprised, because the patient never sees a doctor and does not take medicine. He always thought that he (she) was in good health, but he did not expect to have a stroke. In fact, good health is just an illusion of patients and their families. Stroke patients often have risk factors for stroke and do not know. If these people can detect the disease early and take effective treatment measures, the stroke can be prevented. Therefore, for people aged 40 or older, especially those with a family history of hypertension, diabetes or stroke, regular physical examinations and early detection of early risk factors for stroke can prevent the occurrence of stroke.
2. What are the benefits of strengthening physical exercise to prevent hemiplegia? Practice has proved that physical exercise helps with partiality.
(1) Physical exercise can enhance physical fitness, improve disease resistance and delay aging.
(2) Physical exercise can enhance heart function, improve blood vessel elasticity, promote blood circulation throughout the body, and increase blood flow to the brain.
(3) Physical exercise can lower blood pressure, dilate blood vessels, accelerate blood flow, and reduce blood viscosity and platelet aggregation, thereby reducing thrombosis.
(4) Physical exercise can promote lipid metabolism and increase the content of high-density lipoprotein in the blood, thereby preventing arteriosclerosis. Long-term exercise can reduce weight and prevent obesity.
Therefore, physical exercise is an important measure to prevent hemiplegia.
Complication
Hemiplegia complications Complications , muscle atrophy around the shoulder joint
After the cerebrovascular disease enters the recovery period, if the rehabilitation exercise is not carried out in time, the limbs of the hemiplegia will contract, stiffen, deform, and even cause severe pain, which will bring great pain to the patient.
There are several common causes of limb pain in the ankle:
Shoulder joint subluxation
After the upper limb is completely paralyzed, the muscles around the shoulder joint are relaxed. Under the influence of gravity, the shoulder joint is often pulled and subluxated. The patient often feels pain or discomfort, especially when the subject is passively exercising.
Shoulder hand syndrome
This disease often occurs 1 to 3 months after cerebrovascular disease. It is a common cause of shoulder pain and hand pain after cerebrovascular disease. If it is not treated in time, the consequences are serious and often cause disability.
This disease mainly manifests as ipsilateral shoulder pain, hand pain, upper extremity abduction, supination, and upward lifting limitation. Forced passive exercise is extremely painful. The back of the hand and the fingers are swollen. The wrinkles on the back of the hand disappear, and there is a sense of light. Micro concave, skin redness, increased skin temperature and flexion of the wrist joints.
Periarthritis of the shoulder
It often occurs several months after hemiplegia. In the early clinical stage, the pain of upper arm abduction and ascending is manifested. Later, it gradually worsens. The patient has persistent upper arm and severe pain in the hand, which often makes it difficult for the patient to fall asleep, and hopelessly weeps, and begged the doctor or others. Don't move his shoulders.
In addition, the toes are severely flexed and adducted, the elbow and knee flexors are atrophied, and the Achilles tendon is shortened. When the ground is pressed or moved, it often causes pain in the affected limb.
Symptom
Hemiplegia symptoms Common symptoms Lower limb towing gait slanting angle, unable to speak brain stem infarction, hemiplegic gait, lower extremity, central sacral angle, drooping abdominal wall reflex, weakened or disappeared, finger sacral fissure
Mainly for the movement disorders of one side of the upper and lower limbs. There are four manifestations in clinical practice:
1 disturbance of consciousness disorder: manifested as sudden occurrence of disturbance of consciousness, accompanied by hemiplegia, often with head and eye side deflection.
2 flaccid hemiplegia: manifested as one side of the upper and lower extremity dyskinesia with obvious low muscle tone, voluntary muscle paralysis apparently involuntary muscles can not appear paralysis, such as gastrointestinal exercise, bladder muscle, etc., no obstacles.
3 spasticity hemiplegia: generally caused by flaccid hemiplegia, characterized by marked increase in muscle tone. The extensor muscles of the upper limbs and the flexor muscles of the lower limbs are obvious, and the muscle tension is significantly increased. Therefore, the upper limbs are flexed, the lower limbs are straight, the fingers are flexed, and the passive straight fingers have a stiff resistance.
4 hemiparesis: in the case of extremely mild hemiplegia, such as the early stage of progressive hemiplegia, or the interval of seizures of transient seizures, the sputum is mild, and it is easy to miss if not carefully examined.
Examine
Hemiplegia
Head and face
When the patient has facial paralysis, it can be seen that the nasolabial fold of the hemiplegia side becomes shallow, the eye crack is widened, and the mouth angle is drooping. When exhaling, the cheeks on the side of the hemiplegia bulge; when inhaling, the cheeks on the cheeks are depressed. This is called the "Sail Sail". Patients often have heads and eyes that are skewed to one side. In the midbrain, the lesion is on the side of the lesion, and the head is slightly biased toward the lesion side. When the lesion is below the midbrain and in the pons, the hemiplegic limb is observed, and the head is slightly biased toward the limb side. When the eyes are opened by hand, the side-side resistance is small or no resistance, and the mouth angle is biased to the healthy side. If the force is pressed against the upper incision, the pain reaction is caused, and the normal lateral muscle contraction makes the mouth angle more obvious to the healthy side.
Limb
When the normal person is lying down, the feet are perpendicular to the bed surface. Hemiplegia - hemiplegia - the lateral lower extremity showed an external rotation. When the legs are flexed by 90 degrees, the limbs are quickly passively straightened and pour out. When the upper and lower limbs are placed in an unnatural position, the unfinished limbs will gradually move to a natural position. At the same time, there are often actions such as raising hands, pulling quilts, touching the chest, and stretching and flexing the lower limbs. The hemiplegic limbs did not respond to this. Lift the bilateral limbs, then let go of the natural drop, showing that the limbs fall faster than the healthy side. If the symmetrical part of the lower limbs is stimulated by the same force, the flexion and avoidance of the limbs can be seen, and the limbs do not have this reaction. The hemiplegia muscle tension is also lower than the healthy side, and the tendon reflex is weakened or disappeared. When the degree of coma is deep, the pathological reflex on the hemiplegic side is positive.
Diagnosis
Hemiplegia diagnosis
(a) cortical and subcortical hemiplegia
In the case of cortical hemiplegia, the upper extremity is obvious and the distal end is. If there is cortical irritation, there is seizure. In the case of parietal lobe lesions, there is a cortical sensory disturbance, which is characterized by shallow sensation, that is, tactile, warm and painful, and normal, while physical sensation, positional sensation, and two-point discrimination are obvious. The sensory disturbance is evident at the distal end. Right side cortical hemiplegia is often accompanied by aphasia, disuse, misrecognition and other symptoms (right), bilateral subcortical hemiplegia with conscious disturbance, mental symptoms. Cerebral cortical hemiplegia generally has no muscle atrophy, and may have disuse muscle atrophy in the advanced stage; however, hemiplegia caused by parietal tumor may have obvious muscle atrophy. Cortical or subcortical hemiparesis hyperreflexia, but other pyramidal tract signs are not obvious. Cortical and subcortical hemiplegia are the most common causes of middle cerebral artery disease, followed by trauma, tumor, occlusive vascular disease, syphilitic vascular disease or cerebral embolism caused by heart disease.
(2) Internal cystic hemiplegia
The cystic tract was induced by internal cystic hemiplegia after the injury of the inner capsule. The internal cystic hemiplegia showed upper and lower extremities including the lower facial muscles and the lingual muscles. During hemiplegia, the muscles that are dominated by the bilateral cortex are not involved, namely the masticatory muscles, the throat muscles, and the eyes, trunk, and upper facial muscles. But sometimes the upper facial muscles can be slightly affected, the frontal muscles sometimes have weak visible power, the eyebrows are slightly lower than the contralateral side, and the orbital muscles are weak, but these obstacles are short-lived and quickly return to normal. In the first 2/3 of the hindlimb of the internal capsule, the increase of muscle tension appeared earlier and more obvious. The extensional muscle was easy to appear pathological reflex. The forearm of the internal capsule showed muscle stiffness and the pathological reflex was mainly in the flexor group. The most common cause of internal cystic hemiplegia is bleeding or occlusion of the membranous artery supply area of the middle cerebral artery branch.
(3) Brain stem hemiplegia (also known as cross-biased hemiplegia)
Hemiplegia caused by brain stem lesions is characterized by cross-biased hemiplegia, that is, one side of the cranial nerve palsy and the contralateral upper and lower limbs. The cause is vascular, inflammation and tumors.
1. Midbrain hemiplegia:
(1) Weber's syndrome: it is a typical representative of mid-cerebral cross-biased hemiplegia, which is characterized by lateral oculomotor nerve paralysis and contralateral hemiplegia. Due to oculomotor nerve paralysis, the face appears drooping in the clinic, the pupil is dilated, and the eyeball is in the lower oblique position. Sometimes seeing the eyeball moving sideways to the side, the Foville's syndrome appears, and may be accompanied by a feeling of dullness with the side of the hemiplegia, and cerebellar ataxia. The mechanism is that the lesions are more extensive on the basis of Weber's syndrome, affecting the brainstem lateral center of the eyeball and its path. And the feeling of fiber and cerebellar red nucleus.
(2) Benedikt's symptom group: showed partial hemiplegia on the contralateral side of the lesion, and there was dance and acromosis on the hemiplegia side.
2. pons hemiplegia:
(1) Millard-Gubler's syndrome: ipsilateral facial paralysis and ipsilateral abducens nerve paralysis of the lesion, contralateral hemiplegia of the lesion, showing cross-sectional paralysis. Because the nucleus fibers of the facial nerve intersect at the high level of the pons, they terminate in the facial nucleus in the lower part of the pons, and then the facial nerve fibers are emitted from the sacral nucleus, which goes to the medial side of the nucleus, bypasses the abductor nucleus, and then goes to the ventral medial, at the junction of the pons and the medulla Out of the brain. When the pons of the facial nerve nucleus crosses the cerebral bridge, the ipsilateral facial paralysis of the lesion is reappeared, and the abducens nerve paralysis and the contralateral upper and lower limb pyramidal tract lesions are intersected.
(2) Foville's syndrome: manifested as facial nerve paralysis, abductor nerve paralysis and two eyes to the opposite side of the lesion, in fact, Millard-Gubler's syndrome plus two-eye lateral dyskinesia, it should be called Millard-Gubler-Foville syndrome. If the lesion invades the ipsilateral trigeminal nerve root plexus or the trigeminal nucleus nucleus, the lesion may be dull in the same side.
3. Medullary hemiplegia:
(1) Upper medullary syndrome: cases of contralateral upper and lower extremities, lesions on the same side of the tongue and tendon and tongue muscle atrophy.
(2) Right side of the medullary syndrome; deep sensation and fine sensory disturbance on the opposite side of the lesion.
(3) medullary dorsolateral syndrome (wallenberg's syndrome): sometimes accompanied by hemiparesis. In addition, there are ipsilateral limb ataxia, nystagmus, ipsilateral soft palate, vocal cord paralysis, facial dysfunction, and Horner's disease.
(4) Babinski-Nageotte's syndrome: contralateral hemiplegia and lateral dissociative sensory disturbance, vasomotor disorder. Symptoms of ipsilateral facial dysfunction, cerebellar ataxia, Horner's sign, nystagmus, soft palate, pharyngeal and laryngeal paralysis (Avellis syndrome).
(5) lesions at the intersection of the medulla oblongata: the lesions may have contralateral upper and lower extremities before the crossover.
(four) spinal hemiplegia
1. Below the pyramidal cross-section: when the spinal cord is half-sided, there are upper and lower extremity spasm on the same side of the lesion, but no cranial nerve palsy, deep sensory disturbance on the lesion side, temperature perception and pain disorder on the contralateral side (Brown-S'equard syndrome) ).
2, neck swelling (neck 5 ~ chest 2) damage: hemiplegia can occur. It is characterized by the lower limbs of the lower limbs and the lower limbs of the motor neurons. Various sensory loss, urinary incontinence and neuralgia with upper limbs. There is often a Horner's sign.
