What is hemiplegia?

Hemiplegia, also known as hemiplegia, refers to the movement disorder of one side of the upper and lower limbs, facial muscles and sublingual muscles, and is a common symptom of acute cerebrovascular disease. Although patients with mild hemiplegia can still move, they often bend their upper limbs and straighten their lower limbs when walking. We call this special walking posture hemiplegia gait. Severe patients are often bedridden and lose their ability to live.

Why do people with acute cerebrovascular disease have hemiplegia? Mainly because the motor center of cerebral hemisphere cortex is damaged. According to the division of labor in human cerebral hemisphere, the right cerebral hemisphere manages the movement of the left limb through the motor center; The left hemisphere controls the movement of the right limb through the motor nerve. Lesions on either side will lead to contralateral hemiplegia. The internal capsule is the most prone to pathological changes in both hemispheres of the brain. Because here, the blood is mainly supplied by a small blood vessel called lentiform artery, which is a vertical branch of the middle cerebral artery with small diameter and high pressure, and it is easy to rupture and bleed when it is impacted by blood flow. So it is also called bleeding artery. It is the prone site of cerebral hemorrhage, but when blood pressure drops and blood flow is slow, it is prone to thrombosis. However, the nerve fibers in the internal capsule area are closely arranged, and both ascending and descending fibers pass through here. Once damaged, contralateral hemiplegia, hemiparalysis and hemianopia will appear, which is the so-called "three-deviation sign".

According to the degree of hemiplegia, it can be divided into paresis, incomplete paralysis and total paralysis. Paralysis: manifested as muscle weakness, muscle strength 4 ~ 5, generally does not affect daily life. Incomplete paralysis is serious, with a large range, muscle strength of 2 ~ 4, total paralysis: muscle strength of 0 ~ 1, and paralyzed limbs can't move at all.

How to judge whether coma patients have hemiplegia?

The presence or absence of hemiplegia in coma patients is one of the main basis to distinguish cerebrovascular disease from other coma diseases. However, due to the patient's consciousness disorder, it is difficult to get cooperation, which brings difficulties to judgment. The following examination is helpful for the diagnosis of hemiplegia.

(1) When facial paralysis occurs in patients with head and face, the nasolabial groove on the hemiplegic side is shallow, the eye fissure is widened, and the corners of the mouth are drooping. When exhaling, hemiplegic cheeks protrude; When inhaling, paralyzed cheeks sink, which is the so-called "sail sign". Patients tend to tilt their heads and eyes to one side. Focus above midbrain, the focus is on the focus side, and the head is slightly biased to the focus side; When the lesion is located under the midbrain and pons, gaze at the hemiplegic limb and tilt the head slightly to one side of the hemiplegic limb. When both eyelids are opened by hand, there is little or no resistance on the hemiplegic side, and the mouth angle is biased towards the healthy side. If you press the supraorbital notch hard, it will cause a painful reaction, and the normal lateral muscles will contract, making the inclination of the mouth to the healthy side more obvious.

(2) When a person with normal limbs lies on his back, his feet are perpendicular to the bed surface. In the case of hemiplegia, the lower limbs on the hemiplegic side are in the external rotation position. When the leg flexes 90 degrees, the paralyzed limb quickly stretches out passively and falls out. When the upper and lower limbs are in an unnatural position, the limbs that are not paralyzed will gradually move to the natural position. At the same time, there are often actions such as raising your hand, pulling the quilt, touching your chest and stretching your lower limbs. However, there is no such reaction in hemiplegic limbs. Lift your limbs and let them fall naturally. It can be seen that paralyzed limbs descend faster than healthy limbs. If the symmetrical parts of both lower limbs are stimulated with the same force, the healthy limb can stretch to avoid, but the paralyzed limb does not have this reaction. The muscle tension of hemiplegic side is also lower than that of healthy side, and the tendon reflex is weakened or disappeared. When the coma degree is deep, the pathological reflex of hemiplegia side is positive.

What is the cause of limb swelling on one side of hemiplegia?

Why the hemiplegic limbs swell is a problem that clinicians often encounter, and it is also a question that patients' families often ask. The reason is related to the following factors.

(1) Venous reflux disorder The blood supply of human body is completed by the circulatory system. The circulatory system includes the heart and blood vessels. The blood vessels in the whole body are composed of arteries and veins. Arteries infuse fresh blood into tissues and cells; Veins send used blood from the body back to the heart. The motive force of arterial blood flow comes from every strong contraction of the heart and the elasticity of the blood vessel wall; Venous reflux mainly depends on the pressure difference between it and the heart and the squeezing force of muscle contraction on the blood vessel wall. Because of the thin vein wall and poor elasticity, this squeezing force is particularly important. When quadriplegia occurs, muscles stop contracting due to loss of innervation, so the squeezing force of muscles on venous vessels disappears, leading to venous reflux disorder.

(2) The limb movements of patients with malnutrition and metabolic disorders are innervated by nerves, and the vasomotor function of blood vessels is also innervated by nerves. When the limbs are hemiplegic, they will lose innervation, and the hemiplegic limbs will suffer from malnutrition, which will cause the vasomotor function of blood vessels to be out of balance, slow down the contraction and relaxation reactions, and slow down the venous blood return rate.

Because of the above reasons, the blood can't return to the heart quickly, but the amount of blood stranded in the vein increases, and the pressure in the vein cavity also increases, and the liquid is easily squeezed out of the blood vessel wall and stranded in the tissue gap, thus causing swelling.

Mild limb swelling, by improving the conditions, let venous blood return to the heart as soon as possible, edema will soon disappear, without causing great harm. On the contrary, if the edema stays in the tissue for too long, the protein component will be deposited and become fibrous tissue. If this lesion occurs around the joints, joint stiffness and contracture may occur, so swelling of limbs should be treated actively.

First of all, always exercise passively and massage the affected limb. By kneading, pinching, pinching and pressing, instead of active muscle activity, venous blood vessels are squeezed, venous reflux is promoted, microcirculation is improved, and nutritional and metabolic disorders of affected limbs are corrected.

Secondly, we should pay attention to raising the position of the affected limb. When sitting, use brackets or other supports to raise the forearm or put it on the armrest of the chair. When lying down, the lower limb of the affected side should be padded with 10 ~ 20 cm to reduce the influence of gravity on perfusion, promote venous blood return and reduce the swelling of the affected limb.

Why does hemiplegia have a limb pain?

After cerebrovascular disease enters the recovery period, if rehabilitation exercise is not carried out in time, hemiplegic limbs will contract, stiffen and deform, and even cause severe pain, which will bring great pain to patients.

The common causes of paralysis limb pain are as follows:

(1) After the upper limb is completely paralyzed due to subluxation of the shoulder joint, the muscles around the shoulder joint relax. Under the influence of gravity, the shoulder joint is often pulled and subluxated. Patients often feel pain or discomfort, especially when passive exercise is carried out on the affected limb.

Why is the shoulder joint prone to subluxation? This is determined by the characteristics of the shoulder joint itself. We know that the range of motion of all joints in the whole body is very different. The largest range of motion is the shoulder joint. It can move in almost all directions, enabling us to engage in various daily activities flexibly.

This function of shoulder joint is mainly related to its structure. Because the shoulder socket is shallow and the joint head is round and big, it is of course convenient for activities. However, when the limb is paralyzed, the muscle ligaments around the shoulder joint relax and the function of fixing the joint is weakened. In addition, the shoulder joint will slide down from the articular fossa, and the shape of the shoulder joint will change clinically, causing pain.

(2) Shoulder-hand syndrome, which often occurs 1 ~ 3 months after cerebrovascular disease, is a common cause of shoulder pain and hand pain after cerebrovascular disease. If not treated in time, the consequences will be very serious, often resulting in disability.

The main manifestations of the disease are shoulder pain, hand pain, limited abduction, supination and lifting of upper limbs, severe pain caused by forced and passive exercise, swelling of the back of the hand and fingers, disappearance of skin wrinkles on the back of the hand, light feeling, slight depression, redness of the skin, rising skin temperature and wrist flexion pain.

(3) Periarthritis of shoulder joint often occurs several months after hemiplegia. The early clinical manifestation is the pain of upper arm abduction and elevation, and then it gets worse gradually. Patients with persistent severe pain in their upper arms and hands often make it difficult for them to fall asleep and cry in despair, pleading with doctors or others not to move their shoulders and arms.

In addition, toes are severely flexed and adducted, elbow and knee flexion muscles are developed, and achilles tendon is shortened. When touching the ground, it often causes pain in the affected limb.

Can alternating hemiplegia affect children's intelligence?

Alternating hemiplegia in children is characterized by frequent occurrence of alternating hemiplegia, often accompanied by transient ophthalmoplegia and nystagmus. Incomplete paralyzed limbs have dance movements and autonomic nerve dysfunction. Progressive mental retardation is also a prominent feature of this disease.

The etiology and pathogenesis of this disease are still unclear. Some studies believe that the disease has a certain relationship with migraine, and the pathogenesis may be due to the abnormality or defect of neurometabolic pathway or productivity system in the brain, which affects the cortex and basal ganglia and produces diffuse encephalopathy, and the intermittent deterioration of this defect causes symptoms such as paroxysmal hemiplegia. Excitement, crying, anger, strong light, bathing and special diet can all induce hemiplegia.

The clinical manifestation of the disease is that the age of hemiplegia is less than 18 months. Hemiplegia can occur suddenly or gradually, often alternating left and right, or shifting from one side to the opposite side, or always confined to one side, and a few patients are bilateral paralysis. Hemiplegia is the heaviest in upper limbs, followed by lower limbs, and the lightest in face. Hemiplegic limbs may have tremor, dance-like exercise, cold or fever, pale or red skin, sweating, etc. It can be accompanied by binocular nystagmus and binocular gaze. Hemiplegia appears when the child is awake or active, and disappears after falling asleep, especially after deep sleep.

In addition to hemiplegia, children with this disease are often accompanied by different degrees of mental retardation, such as starting to talk and walking later than other children, abnormal behavior, too much activity, ignorance of danger and so on. In severe cases, there are cognitive impairment, inability to enter school or poor academic performance. These mental retardation gradually increased at first, and stopped developing after a few years.

At present, flunarizine is used to treat this disease, which can obviously reduce the attack frequency and duration of alternating hemiplegia without obvious side effects. There is no preventive measure for this disease, so parents should observe their children carefully. If there is alternating limb paralysis, you should go to the hospital as soon as possible for diagnosis and start treatment.

Can acute hemiplegia in children affect intelligence?

Acute hemiplegia in children is an acquired nervous system syndrome, which is characterized by sudden paralysis of one limb in different degrees under relatively healthy conditions, and most cases have convulsions, mental disorders or coma in the early stage.

The etiology of this disease can be divided into primary and secondary. Primary refers to those whose causes are unknown. The secondary causes are: ① brain trauma, head and neck trauma, cervical fracture or dislocation; ② Central nervous system infection caused by viruses, bacteria, parasites and leptospira; ③ sudden rupture of cerebral hemangioma; ④ Congenital or acquired heart disease causes cerebral thrombosis or cerebral embolism; ⑤ Systemic diseases such as purpura, hemophilia and angiitis obliterans; ⑥ Status epilepticus, tumor, etc.

There are three ways of acute hemiplegia in children: ① Stroke, the most common, sudden convulsion, high fever, coma, hemiplegia, and sometimes convulsion is epileptic. Unilateral visual impairment, language disorder and hemiplegia coexist. ② Acute type, only showing hemiplegia, unconscious changes or only temporary disturbance of consciousness. ③ Intermittent type, temporary weakness of one limb and occlusion of common carotid artery. If the pulse of the paralyzed contralateral carotid artery is weakened, it is of diagnostic significance. The onset determines the nature of the disease, and patients with vascular embolism can get sick within a few minutes; The onset of thrombosis is slow, which can be intermittent or progressive within hours or days, but most of them have no convulsions; Hemangioma rupture, sudden onset, sudden severe headache, pale face and cold sweat.

Paralysis often occurs after convulsions stop. After about 3 ~ 4 months, the motor function gradually recovered, and the function of lower limbs recovered faster than that of upper limbs. About half of them have sequelae of different degrees, and severe limbs are deformed. If the basal ganglia of the brain is damaged, there will be involuntary hand-foot movements or dance-like movements; Facial paralysis, dysphagia, salivation, and unclear pronunciation occur when the brain nerve is damaged; If the temporal lobe, occipital lobe or parietal lobe are damaged, visual impairment, aphasia or sensory impairment may occur; More seriously, there may be mental and behavioral obstacles.

The prognosis of patients under 2 years old is poor. 30% ~ 50% of the survivors have different degrees of mental retardation and can have various types of seizures. The sequelae of behavioral problems and learning difficulties are also common. Therefore, we should pay attention to prevention, actively prevent head and neck trauma, prevent various infections, prevent them from spreading to the central nervous system, and prevent thrombosis in patients with heart disease.

The treatment of this disease should actively seek the cause, treat according to the cause, and treat the symptoms at the same time. Active control of convulsion, hemorrhage and brain edema in acute stage. Paralyzed limbs should rest absolutely, keep functional position and prevent deformity. Encourage early activities after the function recovers slightly, and take acupuncture, massage, massage and physical therapy to help the limbs recover their functions. Try glutamic acid or γ for mentally retarded people after acute stage. Tyrosine. Children who exercise excessively can use ritalin, and education should be strengthened.