Hemiparetic gait is formed as a result of organic lesions of the central nervous system, is detected after stroke, TBI, encephalitis, purulent lesions of the brain. It develops with tumors, parasitosis, toxic, demyelinating and degenerative-atrophic processes. The cause of the occurrence is established according to anamnesis, general and neurological examination, echoencephalography, CT, MRI, laboratory tests, and other studies. At the initial stage of the development of hemiparesis, pathogenetic and symptomatic measures are carried out, followed by rehabilitation.
General information
The gait has a “mowing” character. The arm is bent at the elbow joint, pressed against the trunk. The leg does not move in a straight line, but deviates to the side and describes a semicircle. At the moment of separation from the surface, the knee joint is unbent, the foot is in the position of slight plantar flexion. The patient deflects the trunk to the healthy side and lifts the pelvis, the leg makes a circular motion, is hardly carried forward. Instead of resting on the heel, the foot hits the surface.
Slight spasticity and partial preservation of the functions of the thigh and lower leg muscles allow some patients, instead of lifting the pelvis, to compensate for an unbent knee and a sagging foot by increasing hip flexion. When using a cane, a person holds it with a healthy hand, during a step, the sick leg transfers its weight to it. Less often there is extension in three joints (hip, knee, ankle) with typical vertical movements of the pelvis at each step.
Causes of hemiparetic gait
Stroke
The most common cause of hemiparetic gait formation is stroke. Walking disorders occur in both hemorrhagic and ischemic forms of the disease, develop due to persistent hemiparesis. They can be combined with facial distortion, aphasia, dysarthria, visual-spatial agnosia, and other neurological disorders. The severity of symptoms varies depending on the volume of the affected area in the brain, the time of initiation of therapeutic measures.
TBI
Hemiparetic gait is detected in some patients who have suffered traumatic brain injuries. The cause of hemiparesis can be the direct destruction of the medulla by bone fragments in fractures of the arch and base of the skull, bruising and crushing of the brain matter, compression of brain structures by epidural, subdural and intracerebral hematomas. The clinical picture and severity of residual phenomena differ significantly, correlate with the severity of the injury.
Purulent processes
Brain abscesses develop as a result of open TBI, otogenic complications, infection of wounds after neurosurgical operations, the spread of suppuration in osteomyelitis of the skull bones. The most severe neurological consequences, including hemiparesis with the appearance of hemiparetic gait, are detected in patients with subdural empyema. After epidural purulent foci, gait changes are less frequent.
Encephalitis
Hemiparetic gait is not mandatory, but a possible consequence of encephalitis. The probability of residual motor disorders depends on the type and form of the disease. The symptom can be observed in people who have undergone the following variants of pathology:
- encephalitic form of tick-borne encephalitis;
- hemiparetic form of Japanese mosquito encephalitis;
- hemorrhagic influenza encephalitis;
- measles encephalitis.
Rasmussen’s encephalitis is considered a special type of disease with frequent hemiparetic gait – a condition with an unclear etiology (presumably viral or autoimmune). There is a chronic course with a lesion of one hemisphere of the brain.
Parasitosis
Hemiparetic gait is characteristic of aspergillosis of the brain, since with this pathology, disorders of cerebral circulation and hemiparesis are often observed, resembling those in strokes. For other parasitoses, epileptic seizures are more typical, weakness of half of the body is rare, sometimes noted with echinococcosis.
Intracranial birth injuries
Mechanical damage during childbirth, especially against the background of previous fetal hypoxia, can lead to the development of intracranial hemorrhages. With damage to the corresponding parts of the brain and the pathways, a hemiparetic gait is formed in the outcome. The symptom is revealed with the beginning of walking, motor stereotypes are primarily formed according to the vicious principle caused by hemiparesis.
Oncological diseases
Motor disorders, including hemiparesis, are observed in more than half of patients with cerebral tumors. Symptoms develop gradually, occur against the background of headaches, systemic dizziness, vomiting, unrelated to food intake, focal disorders. Seizures and mental disorders are possible. Hemiparetic gait can be formed with neoplasia of the cortex and subcortical structures, brain stem tumors and craniospinal neoplasms.
The symptom is determined in astrocytomas, meningiomas, medulloblastomas and other primary oncological processes. It is detected in cerebral gliomatosis with a predominant lesion of one hemisphere. In some patients, hemiparesis is found in tumors of other localizations, and is a consequence of metastasis to the brain. Sometimes hemiparetic gait is provoked by neuroleukosis that has arisen against the background of acute leukemia, less often – chronic leukemia.
Other pathologies
The symptom is observed in demyelinating diseases of the brain, for example, progressive multifocal leukoencephalopathy. The number of congenital diseases accompanied by hemiparetic gait includes Sturge-Weber syndrome. A similar gait disorder can be observed in severe toxic brain lesions. Sometimes the cause of cerebral ischemia with subsequent hemiparesis is a delaminating aortic aneurysm and tetrad of Fallot.
Diagnostics
The neurologist is responsible for determining the cause of hemiparetic gait. During the conversation with the patient, the specialist determines the time of the appearance of the symptom, finds out against the background of which diseases and acute conditions neurological disorders have arisen. An important part of the examination is to study the dynamics of the disease to confirm the stable or progressive nature of the disorders. The examination involves the following procedures:
- Clinical study of gait. It is carried out by observation. The movements of the arms, legs and body are evaluated, the length, width, rhythm, symmetry of the step, features of movements in different phases of the step, walking speed, the need to use special devices are determined.
- Neurological examination. It involves the identification of cerebral and focal neurological symptoms, an assessment of the severity of hemiparesis, a study of reflexes, muscle strength and sensitivity in various parts of the body.
- Echoencephalography. An accessible method that allows detecting tumors, hematomas, parasitic foci, brain edema, displacement of brain structures. It is assigned at the preliminary stage of the examination, if necessary, supplemented with clarifying techniques.
- Radiography of the skull. Along with echoencephalography, it is the basic method of research. It is indicated for traumatic injuries. It can be used to diagnose inflammatory processes.
- CT scan of the brain. It makes it possible to determine the size and location of various pathological foci: areas of ischemia, hemorrhages, tumors, inflammatory foci, hematomas, post-traumatic changes. To increase the information content, if necessary, it is made with contrast enhancement.
- MRI of the brain. Native and contrast magnetic resonance imaging is used in the process of final diagnosis of strokes, demyelinating pathologies, neoplasms, traumatic brain injuries, abscesses, parasitic cysts.
- Laboratory tests. In inflammatory processes of any genesis, they are prescribed to determine the severity of inflammation. They help to carry out differential diagnosis of encephalitis by determining the pathogen.
Treatment
Conservative therapy
In the acute period, pathogenetic and symptomatic therapy is indicated for patients. Since hemiparetic gait develops as a result of hemiparesis and is considered within the framework of the long-term consequences of brain damage, restorative techniques play a leading role in eliminating or minimizing the symptom.
At an early stage, measures are taken to prevent contractures, provide a functionally advantageous position of paretic limbs. The greatest effectiveness of rehabilitation is noted during the first year after the onset of neurological disorders. The following methods are used:
- Drug therapy: anticonvulsants, muscle relaxants, medications to improve blood supply to the brain and metabolic processes in the nervous tissue, vitamins of group B.
- Physiotherapy: electrophoresis, electromyostimulation, diadynamotherapy, ultrasound therapy, mud therapy, water procedures, reflexotherapy.
- Active recovery: along with classical methods of therapeutic physical culture, mechanotherapy, classes on special simulators, swimming, hippotherapy are used.
- Manual impact: general and segmental massage, manual therapy.
- Psychotherapy: individual classes, communication and social skills trainings are conducted to restore emotional state, ensure social adaptation.
- Speech restoration: hemiparesis is often combined with speech disorders, many patients require the help of a speech therapist to correct aphasia.
Surgical treatment
Surgical interventions on nerve structures are carried out in the acute phase of the disease, in the long-term period, techniques aimed at correcting orthopedic disorders are more often used. Drainage or removal of abscesses and hematomas, excision of tumors and parasitic cysts are possible. In the early period of ischemic stroke, thrombolysis is effective.
In case of cerebrovascular insufficiency, reconstruction of the vertebral artery or carotid endarterectomy may be indicated. Patients with secondary disorders of the musculoskeletal system undergo operations to eliminate contractures, muscle and tendon movement, arthrodesis and other interventions.