hemiplegia(bàn shēn bù suí)

essential information

pathogeny

The etiology of hemiplegia is diverse and complex. Generally speaking, it has an inseparable relationship with diseases such as high blood lipid and high blood viscosity, which can be summarized as follows: 1. Atherosclerosis is the main cause of stroke, 70% of stroke patients suffer from arteriosclerosis, and hyperlipidemia is one of the main causes of arteriosclerosis. Hypertension is the most common cause of stroke. 93% of patients with cerebral hemorrhage have a history of hypertension. Congenital abnormality of cerebral vessels is a common cause of subarachnoid hemorrhage and cerebral hemorrhage. Heart disease, such as endocarditis, may produce mural thrombus; bradycardia may cause cerebral insufficiency. In metabolic diseases, diabetes is most closely related to stroke, with 30% - 40% of stroke patients suffering from diabetes. 6. Not in a good mood (angry, excited). 7. Improper diet (overeating, improper drinking). 8. Body position changes such as overwork, exertion, excessive exercise, sitting up and getting up suddenly. 9. Climate change; pregnancy; dry stool; watching TV too long; improper use of brain, etc. 10. Improper medication, such as improper use of antihypertensive drugs. Any cause of brain injury can cause hemiplegia. Cerebrovascular disease is the most common cause of hemiplegia. Cerebral trauma, cerebral vascular malformation, cerebral aneurysm, brain tumor, intracerebral infection, encephalopathy and demyelinating disease can all cause hemiplegia.

clinical manifestation

There are four clinical manifestations: 1. Mild hemiplegia in the case of very mild hemiplegia, such as the early stage of progressive hemiplegia, or the interval period of transient paroxysmal hemiplegia, the paralysis is mild, and it is easy to miss if it is not carefully examined. (2) flaccid hemiplegia the symptoms of flaccid hemiplegia are disorder of random movement of upper and lower limbs on one side, accompanied by obvious hypotension of muscle, obvious paralysis of voluntary muscle, but no paralysis of involuntary muscle, such as gastrointestinal movement, bladder muscle and so on. Spastic hemiplegia generally develops from flaccid hemiplegia and is characterized by obvious increase of muscle tension. The extensors of the upper limbs and the flexors of the lower limbs are obviously paralyzed, and the muscle tension is significantly increased. Therefore, the upper limbs are flexing, the lower limbs are straight, the fingers are flexing, and the hands are stiff and resistant when they are stretched passively. 4. Hemiplegia with disturbance of consciousness.

inspect

The examination mainly includes imaging examination and rehabilitation assessment: 1. Imaging examination (1) cerebral angiography. （2）CT。 （3）MRI。 2. Rehabilitation assessment muscle strength, muscle tension, balance function, activities of daily living assessment, Brinell stage, psychological function assessment, etc.

differential diagnosis

1. Cortical and subcortical hemiplegia in cortical hemiplegia, the upper limb paralysis is obvious, especially in the distal part. If there is cortical stimulation, there are seizures. In parietal lobe lesions, there is cortical sensory disturbance, which is characterized by normal superficial sensation, such as tactile sensation and warm pain sensation, while obvious disturbance of entity sense, position sense and two-point discrimination. The sensory disturbance was obvious in the distal part. Right cortical hemiplegia often accompanied by aphasia, apraxia, agnosia and other symptoms (right side), bilateral subcortical hemiplegia with disturbance of consciousness, mental symptoms. Cerebral cortical hemiplegia generally has no muscular atrophy, but disuse muscular atrophy may occur in the late stage; but the hemiplegia caused by parietal lobe tumor may have obvious muscular atrophy. Cortical or subcortical hemiplegic tendon hyperreflexia, but other pyramidal tract signs were not obvious. Cortical and subcortical hemiplegia is most common caused by 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 internal cystic hemiplegia occurs after the pyramidal tract is injured in the internal capsule. The manifestation of internal cystic hemiplegia is paralysis of upper and lower limbs including lower facial muscle and tongue muscle on the opposite side of the lesion. 3. Brainstem hemiplegia (also known as crossed hemiplegia) hemiplegia caused by brainstem lesions is mostly manifested as crossed hemiplegia, namely unilateral cranial nerve paralysis and contralateral upper and lower limb paralysis. The most common causes are vascular disease, inflammation and tumor.

treatment

1. Drug therapy repair damaged glial cells, nerve cell axons and microvessels, increase the nutritional support of damaged brain tissue, improve the repair potential of brain tissue, and carry out comprehensive and in-depth brain repair. In addition to the necessary drug treatment, rehabilitation treatment must be carried out as soon as possible. 2. Physical therapy includes functional point stimulation, electronic biofeedback, range of motion training, muscle stretching training, muscle strength training, transfer training, gait training, etc. 3. Occupational therapy includes basic daily life movements of clothing, food, housing and transportation, occupational labor movements and technical labor movements training, etc. The main purpose is to train the upper limb function and improve the patients' activities of daily living. The purpose is to make patients gradually adapt to the needs of personal life, family life and social life. 4. Traditional rehabilitation therapy includes acupuncture, massage and traditional Chinese medicine fumigation, phototherapy, hydrotherapy, wax therapy, ultrasonic therapy, acupoint magnetic therapy, Chinese and Western medicine direct current induction therapy, etc. 5. Nursing the treatment of hemiplegia takes a long time and needs persistence. We should pay attention to daily nursing, provide nutritious and digestible food, and meet the supply of protein, inorganic salt and total heat energy; implement language training for aphasia patients, which can restore their speaking ability to a certain extent; listen to music, practice musical instruments, sewing, painting, etc. to stimulate the spirit and mood of patients, and use psychotherapy Methods to promote the psychological and physiological rehabilitation of patients.

Prevention and prognosis

1. Regular physical examination is an important measure to prevent stroke and hemiplegia. For people over 40 years old, especially those with hypertension, diabetes or family history of stroke, regular physical examination can prevent the occurrence of stroke. 2. Physical exercise is helpful to hemiplegia recovery; it can strengthen the physique, improve the disease resistance, delay aging; it can enhance the heart function, improve the elasticity of blood vessels, promote the blood circulation of the whole body, and improve the blood flow of the brain; it can reduce blood pressure, expand blood vessels, accelerate blood flow, and reduce blood viscosity and platelet aggregation, so as to reduce thrombosis; it can promote the development of blood circulation Lipid metabolism, improve the content of high density lipoprotein in the blood, which can prevent arteriosclerosis. Long term exercise can reduce weight and prevent obesity. Therefore, physical exercise is an important measure to prevent hemiplegia.

Is progressive hemiplegia cerebral thrombosis?

"If cerebral thrombosis is an acute disease, it should be distinguished from other acute cerebrovascular diseases such as cerebral embolism and cerebral hemorrhage. But if it is chronic, it should be differentiated from other chronic diseases.

Gao Shan, chief physician, Department of Neurology, Peking Union Medical College Hospital

What is the recovery process of hemiplegia?

"Through long-term clinical observation, foreign scholars have found the general law of the recovery process of hemiplegia, and according to this law, the whole recovery process is roughly divided into six stages.

Chief physician Xu Xiaofeng, Department of traditional Chinese medicine, Hangzhou Sanatorium, Nanjing Military Region

Why is left cerebral apoplexy and right hemiplegia?

There is a "pyramidal cross" in the medulla oblongata, where most of the motor nerve fiber tracts descending from the brain, diencephalon, cerebellum and brainstem intersect. The nerve fiber tracts on the left go right and those on the right go left. So the location of the lesion is different, the clinical manifestations are not the same. The phenomenon of cross innervation can be seen in the lesions above the pyramidal junction. For example, the nerve fibers in the left hemisphere of the brain can control the movement and sensation of the right limbs and the muscles of the face and tongue

Gao Shan, chief physician, Department of Neurology, Peking Union Medical College Hospital

Why are the upper and lower limbs not the same weight when hemiplegia?

As far as the most common types of stroke - cerebral infarction and cerebral hemorrhage are concerned, most of the lesions are located in the middle cerebral artery of the cerebral hemisphere. The blood supply of the middle cerebral artery almost includes the frontal lobe, parietal lobe and deep basal ganglia of the hemisphere, that is, the motor cortex, sensory cortex and their conductive fibers. Therefore, stroke lesions of the middle cerebral artery system are easy to cause hemiplegia and hemisensory disturbance of the contralateral limbs. However, the motor and sensory cortex that dominates the lower limbs and they

Gao Shan, chief physician, Department of Neurology, Peking Union Medical College Hospital

How can hemiplegic patients be placed in a good position?

"In the early stage of hemiplegia, supine position, healthy lateral position and affected lateral position can be taken in turn. It is better to take more lateral position, and supine position is generally less used.

Chief physician Xu Xiaofeng, Department of traditional Chinese medicine, Hangzhou Sanatorium, Nanjing Military Region

Expert interpretation

Ma Zhenxing, chief physician, director of Department of Neurology, West China Hospital of Sichuan University.

< ptitle = "an overview of hemiplegia" > an overview of hemiplegia

Chinese PinYin : bàn shēn bù suí