Hemiparesis occurs with disorders of cerebral circulation, tumors, craniocerebral injuries, purulent and infectious processes, parasitosis, some types of epilepsy, toxic brain damage. The cause of hemiparesis is established by the results of a survey, neurological examination, echoencephalography, radiography, tomography, laboratory tests. Treatment includes pathogenetic and symptomatic therapy followed by restorative measures. Sometimes surgery is required.
Hemiparesis is a decrease in muscle strength in the right or left half of the body, due to damage to cortical neurons or pathways. When passing from the brain to the spinal nerve pathways cross, so hemiparesis in most cases develops on the side opposite to the pathological focus.
May develop acutely or gradually. Often combined with aphasia, cognitive disorders, impaired pelvic functions. With simultaneous involvement of the brain stem and nuclei of the cranial nerves, alternating syndromes are formed - conditions in which hemiparesis, on the one hand, is combined with loss of functions of one or more cranial nerves, on the other hand.
Strokes are characterized by acute manifestation, rapid progression of symptoms, and the persistent nature of disorders. Hemorrhagic stroke develops rapidly. In the debut, cerebral manifestations predominate, which are joined by signs of a focal lesion. For ischemic stroke, a slower increase in symptoms is typical, the predominance of focal manifestations over cerebral ones.
When the brain is damaged in the basin of the carotid arteries, central hemiparesis is formed with a loss or decrease in muscle strength, an increase in muscle tone. Smoothing of the nasolabial fold, distortion of the face, lagophthalmos are revealed. Possible hemianopsia, apraxia, aphasia, violations of criticism. With lacunar strokes, hemiparesis can be observed in isolation.
In patients with transient disorders of cerebral circulation, hemiplegia and hemiparesis are rarely diagnosed, the decrease in muscle strength is slight or moderate. Dysarthria and anisoreflexia may be present. Sometimes there are epileptic seizures. All neurological functions are fully restored within a day.
Hemiparesis develops in every second patient with a brain tumor. Violations progress gradually, appear against the background of cerebral symptoms (dizziness, headache, vomiting that does not bring relief) and focal manifestations. They are detected with the involvement of the motor cortex, stem lesions and craniospinal neoplasia.
Hemiplegia or hemiparesis are determined in patients with pineoblastomas, meningiomas, astrocytomas, medulloblastomas, other primary tumors, cerebral metastases with the spread of malignant neoplasia of other organs. With predominantly unilateral localization of pathological foci, weakness of the muscles of one half of the body may be accompanied by cerebral gliomatosis, carcinomatosis of the meninges. Sometimes the cause of hemiparesis is neuroleukemia.
The phenomena of hemiparesis are found in victims with craniocerebral injuries. With a slight bruise of the brain, muscle weakness is short-term, not always detected. For a brain contusion of moderate severity, hemiparesis persists for 1-1.5 months. In severe bruises, neurological symptoms partially regress, persistent residual consequences are observed.
The cause of hemiparesis can be subarachnoid hemorrhage, intracerebral, subdural or epidural hematoma. Unilateral muscle weakness is considered one of the most permanent symptoms of hematoma, often occurs after a light interval, is supplemented by headache, psychomotor agitation, impaired consciousness, vomiting, aphasia, anisocoria, bradycardia, and increased blood pressure.
Hemiparesis
Brain abscess is the result of trauma, postoperative complications, hematogenous spread of infection in inflammatory lung diseases. A significant role in the structure of pathology is occupied by otogenic intracranial complications. The likelihood of developing hemiparesis is determined by the location and extent of the abscess. The clinical picture includes cerebral and focal manifestations. Empyema may present with meningeal symptoms.
Hemiparesis is sometimes formed with encephalitis (post-vaccination, Japanese mosquito, tick-borne, influenza) and meningoencephalitis. A high risk of this disorder is noted in vascular neuroAIDS - vasculitis of the cerebral vessels, which is characterized by the transition of ischemic strokes to hemorrhagic ones. In addition, hemiparesis is detected with progressive multifocal encephalopathy, which often develops in patients with AIDS.
Stroke-like symptoms with hemiparesis are sometimes observed in the later stages of neurosyphilis. As a rare cause of unilateral muscle weakness, syphilitic gumma can be considered, which is located mainly in one half of the brain stem, compresses the pathways as it increases.
Cerebral palsy is characterized by a variety of manifestations and a significant variability in the clinical picture. Monotetra or hemiparesis are possible. Increased muscle tone, dysarthria are typical. With damage to the muscles of the larynx and pharynx, dysphagia is observed. Hyperkinesias, epilepsy, intellectual disorders are often detected. Due to the developmental delay of the involved limbs, skeletal deformities form as the child grows.
Todd's paralysis occurs after an epileptic seizure, manifested by central hemiparesis, less often by monoparesis of varying severity. The symptom persists for 1-2 days, then the muscle strength is gradually restored. The pathological condition is more often observed after prolonged epilepsy, secondary generalized seizures and paroxysms of Jacksonian epilepsy.
Kozhevnikovskaya epilepsy has a secondary character, develops against the background of Rasmussen's encephalitis, tick-borne encephalitis, neurosyphilis. It occurs with tumors, strokes, tuberculous meningoencephalitis, and other diseases. Along with simple partial seizures and myoclonus, it manifests itself as hemiparesis, depression, phobias, and sometimes psychopathic disorders.
Aspergillosis may present with fever and cerebral or stroke-like symptoms. Neurological deficit is formed in the first days after the onset of the disease, hemiparesis is complemented by dysarthria, smoothness of the nasolabial fold, facial numbness. With rapid progression, disturbances of consciousness are possible.
The symptom can be found in the following pathologies:
Hemiparesis is sometimes diagnosed with tetralogy of Fallot and dissecting aortic aneurysm. In the first case, muscle weakness is formed after dyspnea-cyanotic attacks, in the second case, it is the result of cerebral ischemia due to tearing of the aortic wall, hematoma formation and compression of arterial branches.
Determining the cause of hemiparesis is the responsibility of a neurologist. During the interview, the specialist finds out the time of occurrence and the rate of progression of the symptom, establishes the presence of other complaints. To clarify the diagnosis, the following methods are used:
Exercise therapy for hemiparesis
The tactics of treatment is determined by the stage of the disease and the duration of the existence of hemiparesis. In the acute period, pathogenetic and symptomatic measures are carried out, and complications are prevented. In the future, restorative techniques play a leading role. The treatment regimen includes:
Taking into account the etiology of hemiparesis, the following operations are performed:
In the remote period, patients may be shown orthopedic interventions. Possible joint redressing in contractures, arthrodesis in a functionally advantageous position, transplantation of tendons and muscles.