Hemiparesis occurs in disorders of cerebral circulation, tumors, traumatic brain injuries, purulent and infectious processes, parasitosis, some types of epilepsy, toxic brain lesions. The cause of hemiparesis is determined by the results of a survey, neurological examination, echoencephalography, radiography, tomographic studies, laboratory tests. Treatment includes pathogenetic and symptomatic therapy followed by restorative measures. Sometimes operations are required.
Characteristics of hemiparesis
Hemiparesis is a decrease in muscle strength in the right or left half of the body due to damage to cortical neurons or pathways. During the transition from the brain to the spinal cord, the nerve pathways cross, therefore, hemiparesis in most cases develops on the side opposite to the pathological focus.
It may develop acutely or gradually. It is often combined with aphasia, cognitive disorders, and pelvic dysfunction. With simultaneous involvement of the brain stem and cranial nerve nuclei, 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.
Сauses of hemiparesis
Strokes are characterized by acute manifestation, rapid progression of symptoms, persistent nature of disorders. Hemorrhagic stroke develops rapidly. In the debut, cerebral manifestations prevail, which are joined by signs of focal lesion. For ischemic stroke, a slower increase in symptoms is typical, the predominance of focal manifestations over cerebral ones.
With brain damage, central hemiparesis is formed in the carotid artery basin with loss or decrease of muscle strength, increased muscle tone. Smoothing of the nasolabial fold, facial distortion, lagophthalmos are revealed. Hemianopsia, apraxia, aphasia, violations of criticism are possible. In lacunar strokes, hemiparesis can be observed in isolation.
In patients with transient disorders of cerebral circulation, hemiplegia and hemiparesis are rarely diagnosed, a decrease in muscle strength is insignificant or moderate. Dysarthria, anisoreflexia may be detected. Sometimes epileptic seizures occur. 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 general cerebral symptoms (dizziness, headache, vomiting, which does not bring relief) and focal manifestations. They are detected with the involvement of the motor parts of the cortex, stem lesions and craniospinal neoplasia.
Hemiplegia or hemiparesis is determined in patients with pineoblastomas, meningiomas, astrocytomas, medulloblastomas, other primary tumors, cerebral metastases with the spread of malignant neoplasms of other organs. With predominantly unilateral localization of pathological foci, weakness of the musculature of half of the body may accompany cerebral gliomatosis, carcinomatosis of the membranes of the brain. Sometimes the cause of hemiparesis becomes neuroleukosis.
Hemiparesis phenomena are found in victims with traumatic brain injuries. With a slight brain injury, muscle weakness is short-term, it is not always detected. For a brain injury of moderate severity, the preservation of hemiparesis for 1-1.5 months is characteristic. With severe bruises, neurological symptoms regress partially, persistent residual effects are observed.
The cause of hemiparesis may be a subarachnoid hemorrhage, intracerebral, subdural or epidural hematoma. Unilateral muscle weakness is considered one of the most persistent symptoms of hematoma, often occurs after a light interval, supplemented by headache, psychomotor agitation, impaired consciousness, vomiting, aphasia, anisocoria, bradycardia, increased blood pressure.
Brain abscess becomes a consequence of injuries, postoperative complications, hematogenic spread of infection in inflammatory lung diseases. Otogenic intracranial complications play a significant role in the structure of pathology. The probability of developing hemiparesis is determined by the localization and prevalence of the abscess. The clinical picture includes cerebral and focal manifestations. With empyema, meningeal symptoms may be detected.
Hemiparesis is sometimes formed with encephalitis (postvaccinal, Japanese mosquito, tick-borne, influenza) and meningoencephalitis. A high risk of this disorder is noted in vascular neurospid – cerebral vascular vasculitis, which is characterized by the transition of ischemic strokes into hemorrhagic ones. In addition, hemiparesis is detected with progressive multifocal encephalopathy, which develops more often in AIDS patients.
Stroke-like symptoms with hemiparesis phenomena are sometimes observed in the late stages of neurosyphilis. As a rare cause of unilateral muscle weakness, syphilitic gum can be considered, which is located mainly in one half of the brain stem, squeezing the pathways as it increases.
Cerebral palsy is characterized by a variety of manifestations and significant variability of the clinical picture. Mono-tetra or hemiparesis are possible. Typical increase in muscle tone, dysarthria. When the muscles of the larynx and pharynx are affected, dysphagia is observed. Hyperkinesis, epilepsy, and intellectual disabilities are often detected. Due to the lag of the involved limbs in development, skeletal deformities form as the child grows.
Todd’s paralysis occurs after an epileptic seizure, manifested by central hemiparesis, less often – monoparesis of varying severity. The symptom persists for 1-2 days, then muscle strength gradually recovers. The pathological condition is more often observed after prolonged epistatus, secondary generalized seizures and paroxysms of Jackson’s epilepsy.
Kozhevnikovskaya epilepsy has a secondary character, develops against the background of Rasmussen’s encephalitis, tick-borne encephalitis, neurosyphilis. It occurs in tumors, strokes, tuberculous meningoencephalitis, and other diseases. Along with simple partial seizures and myoclonia, hemiparesis, depression, phobias, and sometimes psychopathic disorders are manifested.
Aspergillosis can manifest with fever and general cerebral symptoms or manifestations resembling CVA. Neurological deficit is formed already in the first days after the onset of the disease, hemiparesis is supplemented by dysarthria, smoothness of the nasolabial fold, numbness of the face. With rapid progression, disturbances of consciousness are possible.
The symptom can be detected in the following pathologies:
- Sturge-Weber syndrome. Congenital angiomatosis is manifested by vascular spots on the skin of the face, the formation of angiomas on the body and brain membranes. Due to the predominantly homolateral nature of the lesion, hemiparesis prevails among the motor disorders.
- Birth injuries. The cause of the disorder is intracranial hemorrhage in the pathways or motor parts of the brain against the background of trauma during childbirth. Muscle weakness is present from birth.
- Hypertensive encephalopathy. Mild hemiparesis is observed in pyramidal syndrome. It can be supplemented with cephalgia, dizziness, decreased cognitive abilities, psychoemotional disorders.
Hemiparesis is sometimes diagnosed with tetrad Fallot and dissecting aortic aneurysm. In the first case, muscle weakness is formed after dyspnea-cyanotic attacks, in the second – 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 survey, the specialist finds out the time of occurrence and the rate of progression of the symptom, determines the presence of other complaints. To clarify the diagnosis, the following methods are used:
- Neurological examination. The doctor examines reflexes, evaluates the sensitivity and strength of muscles on the healthy and diseased sides, and detects other neurological manifestations.
- Echoencephalography. The basic method used for the primary diagnosis of tumors, hematomas, abscesses, parasitic foci, confirmation of displacement of brain structures.
- Vascular research. Rheoencephalography and vascular ultrasound are performed to assess the state of cerebral circulation.
- Radiography of the skull. It is included in the mandatory examination program for TBI, is assigned to determine the nature and severity of fractures. It is informative for abscesses that have arisen against the background of osteomyelitis of the bones of the skull.
- CT scan of the brain. It is used for a detailed study of volumetric formations, differentiation of strokes, clarification of the nature and prevalence of inflammatory changes. It can be native or contrasting.
- MRI of the brain. It is performed at the final stage of diagnosis. It is recommended for TBI, neoplasia, strokes, abscesses, aspergillosis. If there are indications, it is supplemented by MR angiography.
- Laboratory tests. They are necessary to establish the etiology and severity of inflammation, to assess the state of the body in tumors and purulent processes. In some cases, morphological examination of the material obtained during stereotactic biopsy is performed to determine the type and degree of differentiation of neoplasia.
Treatment tactics are 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, complications are prevented. In the future, restorative techniques play a leading role. The treatment regimen includes:
- Drug therapy: antibiotics, muscle relaxants, anticonvulsants and vascular agents, drugs to stimulate local metabolism, neuroprotectors, B vitamins.
- Physiotherapy procedures: electromyostimulation, reflexotherapy, electrophoresis, diadinotherapy, ultrasound, water procedures, mud applications.
- Manual impact: various types of massage and manual therapy.
- Active rehabilitation: physical therapy, programs for the restoration of motor skills in self-care, mechanotherapy, swimming, the use of special simulators.
- Psychotherapy: individual sessions with a psychologist are aimed at adapting to changes in health status, preventing depression. They are supplemented by group trainings on improving household and social skills.
- Working with a speech therapist: speech therapy classes are shown to patients with speech disorders.
Taking into account the etiology of hemiparesis, the following operations are performed:
- Circulatory disorders: thrombolysis, extra-intracranial anastomosis, reconstruction of the vertebral artery, carotid endarterectomy, AVM removal, aneurysm occlusion.
- Tumors: removal of intracerebral tumors and brain stem neoplasms, excision of metastatic neoplasia, stereotactic surgery, embolization.
- Injuries: transcranial, stereotactic or endoscopic removal of hematomas.
- Purulent processes: drainage of abscesses and empyema, transcranial excision of the abscess together with the capsule.
In the long-term period, orthopedic interventions may be shown to patients. Joint redressation with contractures, arthrodesis in a functionally advantageous position, tendon and muscle transplantation are possible.