Early symptoms of hemiplegia

We often hear about hemiplegia in many elderly people, because when they are old, they may suddenly suffer from cerebral infarction or physical problems due to emotional excitement, which may cause hemiplegia in an instant and may also lead to mental disorders. This requires special attention. In addition, patients may suffer from trauma, tumors, and vascular diseases. In particular, there are many other problems that are the causes of hemiplegia. Patients not only have reduced mobility, but also cannot take care of themselves.

Symptoms

1. Cortical and subcortical hemiplegia

In cortical hemiplegia, paralysis of the upper limbs is obvious, especially in the distal part. If cortical irritation occurs, there may be an epileptic seizure. When the parietal lobe is diseased, there is cortical sensory impairment, which is characterized by normal superficial sensations such as touch, temperature and pain, while solid sense, position sense and two-point discrimination sense are obviously impaired.

Sensory impairment is more obvious in the distal part. Right-sided cortical hemiplegia is often accompanied by symptoms such as aphasia, apraxia, and agnosia (right-handedness), and bilateral subcortical hemiplegia is accompanied by impaired consciousness and mental symptoms. There is generally no muscle atrophy in cerebral cortical hemiplegia, but disuse muscle atrophy may occur in the late stage; however, hemiplegia caused by parietal lobe tumors may have obvious muscle atrophy. The cortical or subcortical hemiplegic tendon reflexes are hyperactive, but other pyramidal tract signs are not obvious. Cortical and subcortical hemiplegia is most commonly caused by middle cerebral artery lesions, followed by cerebral embolism caused by trauma, tumors, occlusive vascular disease, syphilitic vascular disease, or heart disease.

(II) Internal cystic hemiplegia

Internal cystic hemiplegia occurs when the pyramidal tract is damaged in the internal capsule. Internal cystic hemiplegia is manifested by paralysis of the upper and lower limbs, including the lower facial muscles and tongue muscles, on the opposite side of the lesion. In hemiplegia, muscles innervated by bilateral cortices are spared, namely the muscles of mastication, pharyngeal muscles, and the muscles of the eyes, trunk, and upper face. However, the upper facial muscles may be slightly affected sometimes, and the frontalis muscle may sometimes be weak, resulting in the eyebrows being slightly lower than the opposite side. The orbicularis oculi muscle may also be weak, but these disorders are short-lived and quickly return to normal. When the anterior 2/3 of the internal capsule of the hind limb is damaged, increased muscle tone appears early and obviously, and pathological reflexes of the extensor muscles are easy to appear. When the internal capsule of the forelimb is damaged, muscle rigidity occurs, and pathological reflexes are mainly in the flexor muscle group. The most common cause of internal cystic hemiplegia is hemorrhage or occlusion of the lenticulostriate artery supplying the middle cerebral artery.

(III) Brainstem hemiplegia (also known as crossed hemiplegia) Hemiplegia caused by brainstem lesions often manifests as crossed hemiplegia, that is, paralysis of the cranial nerves on one side and paralysis of the upper and lower limbs on the opposite side. The most common causes are vascular, inflammatory and tumor.

Midbrain hemiplegia: (1) Weber's syndrome: It is a typical representative of midbrain crossed hemiplegia, characterized by oculomotor nerve paralysis on the lesion side and hemiplegia on the contralateral side of the lesion. Due to the paralysis of the oculomotor nerve, the face droops, the pupils are dilated, and the eyeballs are in an exotropia position.

Sometimes, paralysis of the eye movements to the side is seen, which is Foville's syndrome, and may be accompanied by sensory loss on the side of the hemiplegia and cerebellar ataxia. Its mechanism is that the lesion range is more extensive on the basis of Weber's syndrome, affecting the brainstem lateral vision center and its pathway of the eyeball. As well as sensory fibers and cerebellar red nucleus bundle. (2) Benedikt's symptom group: manifested by incomplete hemiplegia on the side opposite to the lesion, with chorea and athetosis on the hemiplegic side.