Hemiplegia Onset & Symptoms Quiz
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Questions and Answers

What is the duration of the stage of flaccidity in acute lesions?

  • 6-8 weeks
  • 8-12 weeks
  • 1-2 weeks
  • 2-6 weeks (correct)

    • Which of the following symptoms is NOT associated with the stage of flaccidity?

  • Complete absence of voluntary movement
  • Drooping of the face
  • Hypotonia
  • Exaggerated deep reflexes (correct)

    • In the stage of spasticity, which muscles are more affected in upper limbs?

  • Flexors and extensors are not affected
  • Extensors are weaker than flexors (correct)
  • Both are equally affected
  • Flexors are weaker than extensors

    • What does hypertonia signify in the context of spastic paralysis?

    <p>Increased muscle tone</p> Signup and view all the answers

    Which characteristic reflects the typical muscle involvement pattern seen in hemiplegia?

    <p>Antigravity muscles are more affected than progravity muscles</p> Signup and view all the answers

    During the flaccid paralysis stage, which condition can prolong this stage?

    <p>General poor health condition</p> Signup and view all the answers

    What is a common symptom of hemiplegia during the stage of spasticity?

    <p>Weakness of one side of the body</p> Signup and view all the answers

    Which reflex change occurs in the stage of spasticity?

    <p>Dominance of primitive reflexes</p> Signup and view all the answers

    What reflexes are typically exaggerated on the paralyzed side in depth reflexes?

    <p>Biceps, triceps, knee and ankle reflexes</p> Signup and view all the answers

    Which of the following reflexes is considered lost on the paralyzed side after a cerebrovascular accident?

    <p>Abdominal reflex</p> Signup and view all the answers

    What gait is commonly observed in patients who can walk after a stroke with spasticity?

    <p>Circumduction gait</p> Signup and view all the answers

    Which option is NOT a common cause of shoulder pain following a stroke?

    <p>Tendinitis of rotator cuff</p> Signup and view all the answers

    What is indicated by a positive Babinski sign on the paralyzed side?

    <p>Dorsiflexion of the big toe</p> Signup and view all the answers

    What recovery factor is NOT mentioned as influencing motor function recovery after a stroke?

    <p>Increment of muscle strength</p> Signup and view all the answers

    During the flaccid stage after a stroke, what is the aim of physiotherapy?

    <p>Save the patient's life and prevent complications</p> Signup and view all the answers

    Which reflexes are associated with primitive reflexes that can be unmasked in patients?

    <p>ASTNR and STNR reflexes</p> Signup and view all the answers

    Which of the following describes the main distinguishing feature of Brown-Sequard syndrome?

    <p>Ipsilateral hemiplegia and ipsilateral deep sensory loss</p> Signup and view all the answers

    What is the most common underlying cause of intracranial hemorrhage?

    <p>Hypertension</p> Signup and view all the answers

    Which type of vascular cause is associated with slow circulation leading to thrombosis?

    <p>Thrombotic causes</p> Signup and view all the answers

    In an embolic cause of cerebral infarction, which is considered the most common source of emboli?

    <p>Atrial fibrillation due to mitral stenosis</p> Signup and view all the answers

    What is the clinical presentation of crossed hemiplegia typically associated with?

    <p>Brain stem lesions on one side</p> Signup and view all the answers

    Which scenario is least likely to be a cause of subdural hemorrhage?

    <p>Rupture of an intracranial aneurysm</p> Signup and view all the answers

    What is the most significant vascular condition leading to cerebral infarction?

    <p>Cerebral atherosclerosis</p> Signup and view all the answers

    When diagnosing intracranial issues, which imaging technique is preferred for confirmation?

    <p>MRI and CT</p> Signup and view all the answers

    What is the primary goal during the flaccid stage of recovery?

    <p>Stimulate muscle on the affected side for active participation</p> Signup and view all the answers

    Which of the following methods is not included in the flaccid stage of recovery?

    <p>Local anesthesia for pain management</p> Signup and view all the answers

    What is a key characteristic of the spastic stage in muscle recovery?

    <p>Improving trunk control and minimizing spasticity</p> Signup and view all the answers

    Which technique is primarily used to improve postural reactions during the spastic stage?

    <p>Facilitatory proprioceptive stimuli</p> Signup and view all the answers

    Which of the following methods aims to decrease shoulder pain during the spastic stage?

    <p>Resisted and endurance exercises</p> Signup and view all the answers

    What is the primary focus of proprioceptive techniques in the spastic stage?

    <p>To enhance muscle strength and control selectivity</p> Signup and view all the answers

    Which intervention is NOT aimed at improving flaccid muscle recovery?

    <p>Endurance training for muscle strengthening</p> Signup and view all the answers

    What developmental levels are promoted in postural reactions during the recovery stages?

    <p>Higher developmental levels including righting and equilibrium</p> Signup and view all the answers

    What is the characteristic of a capsular lesion?

    <p>Complete hemiplegia with ipsilateral facial paralysis.</p> Signup and view all the answers

    Which symptom is observed in Brown-Sequard syndrome?

    <p>Ipsilateral deep sensory loss.</p> Signup and view all the answers

    What distinguishes a subcortical lesion from a cortical lesion?

    <p>More extensive paralysis.</p> Signup and view all the answers

    What is the expected outcome of a lesion located in the dominant hemisphere of the cortex?

    <p>Aphasia and agraphia.</p> Signup and view all the answers

    Which of these symptoms is NOT associated with a cortical lesion?

    <p>Ipsilateral hemiplegia.</p> Signup and view all the answers

    In a crossed hemiplegia scenario, which statement is accurate?

    <p>Deep sensory loss occurs contralaterally.</p> Signup and view all the answers

    Which characterizes a lesion in the spinal cord between C1 and C5 segments?

    <p>Ipsilateral hemiplegia with contralateral pain loss.</p> Signup and view all the answers

    What symptom combination defines a capsular lesion?

    <p>Complete hemiplegia and hemi-hyposthesia on the opposite side.</p> Signup and view all the answers

    Study Notes

    Hemiplegia Onset & Course

    • Acute onset and regressive course: Commonly caused by vascular, infective, or traumatic lesions.
    • Gradual onset and progressive course: Usually associated with neoplastic lesions (tumors).
    • Remittent and relapsing course: Characteristic of conditions like Multiple Sclerosis (MS).

    Hemiplegia Symptoms and Signs: Acute Lesions

    • Stage of flaccidity (Flaccid Paralysis, Shock Stage): Lasts 2 - 6 weeks. Shorter duration indicates a better prognosis.
      • Complete absence of voluntary movement: Affected limb(s) show no voluntary movement due to severe muscle weakness.
      • Hypotonia: Muscles are extremely soft and floppy due to reduced muscle tone.
      • Absence of reflexes: Tendon reflexes may be absent, and there may be no plantar response.
      • Drooping of the face: Facial muscles on the affected side may sag, leading to asymmetrical facial appearance.
      • Difficulty in swallowing and speaking: Dysphagia (difficulty swallowing) and dysarthria (difficulty speaking) may be present.
    • Stage of spasticity (Spastic Paralysis, Stage of Established Hemiplegia):
      • Weakness of one side of the body: Affects the progravity muscles more than the antigravity muscles.
        • Upper Limb (UL): Extensors are weaker than flexors
        • Lower Limb (LL): Flexors are weaker than extensors
      • Hypertonia (spasticity): Spastic paralysis of the antigravity muscles, resulting in a clasp-knife type paralysis. This follows a pyramidal distribution pattern.
        • UL: Flexors are more spastic than extensors.
        • LL: Extensors are more spastic than flexors.
        • UL & LL: Adductors are more spastic than abductors.
      • Deep reflexes: Exaggerated on the paralyzed side (biceps, triceps, knee, and ankle reflexes). Pathological deep reflexes (normally absent) may appear: finger reflex, patellar reflex, adductor reflex. Clonus may be elicited in the ankle, less frequently in the knee or wrist.
      • Lost superficial reflexes: The abdominal reflex is lost on the paralyzed side.
      • Positive Babinski sign: Dorsiflexion of the big toe with or without fanning of the other toes upon eliciting the plantar response.
      • Reappearance of primitive reflexes: ASTNR, STNR, TLS, TLP, TLR, TTR, PSR

    Hemiplegia Symptoms and Signs: Gradual Lesions

    • Hemiplegia progresses directly to the stage of spasticity.

    Factors Influencing Hemiplegia Recovery

    • Reduction of cerebral edema
    • Absorption of damaged tissue
    • Improved local vascular flow
    • Lateral sprouting (plasticity)

    Common Causes of Shoulder Pain in Stroke

    • Shoulder subluxation
    • Impingement syndrome
    • Frozen shoulder
    • Shoulder hand syndrome

    Hemiplegia Assessment and Planning

    • General examination: Routine physical assessment
    • Neurological examination:
      • Examination of mental function
      • Examination of speech
      • Examination of cranial nerves
      • Examination of motor system
      • Examination of sensory system
      • Examination of coordination
      • Examination of postural mechanism
      • Examination of synergies
      • Examination of gait
      • Examination of daily living activities (ADL)

    Hemiplegia: Flaccid Stage (Stage of Shock)

    • Description: Characterized by low muscle tone or flaccidity. The duration varies from a short period to several weeks or months. Short duration is associated with a better prognosis.
    • Physiotherapy aims:
      • Save the patient's life (improve respiration, circulation, and prevent secondary complications like DVT).
      • Improve postural reactions (trunk control, righting reactions, protective reactions, postural tone).
      • Minimize the effects of tonal abnormality.
      • Increase sensory awareness (orientation of the affected side).
      • Maintain range of motion and prevent secondary complications.
      • Stimulate muscles on the affected side (encourage active participation of the patient).
      • Prepare the patient for sitting up and standing (early mobility).
      • Improve orofacial function.

    Hemiplegia: Flaccid Stage: Physiotherapy Methods

    • Save patient life: Respiratory exercises, circulatory exercises, improved renal function, and careful attention to patient's nutrition.
    • Improve postural reaction: Improve trunk control and promote the development of higher-level postural reactions (righting, equilibrium, and protective). Reduce primitive reflexes.
    • Facilitation techniques:
      • Proprioceptive stimuli
      • Exteroceptive stimulation
      • Vestibular facilitation
      • Positioning
      • ROM exercises
      • Orofacial training

    Hemiplegia: Spastic Stage (Stage of Established Hemiplegia)

    • Goals:
      • Facilitate selectivity (fractionation)
      • Improve postural reactions and trunk control
      • Minimize the effect of spasticity
      • Increase strength of weak muscles
      • Decrease shoulder pain
      • Improve joint proprioception
      • Improve locomotion

    Hemiplegia: Spastic Stage: Physiotherapy Methods

    • Improve fractionation: PNF technique
    • Improve postural reaction: Improve trunk control and promote higher-level postural reactions (righting, equilibrium, and protective). Reduce primitive reflexes.
    • Inhibitory techniques:
      • Proprioceptive inhibition
      • Local anesthesia
      • Vestibular inhibition
      • Resisted and endurance exercises
      • Decrease shoulder pain
      • Proprioceptive exercises
      • Gait training

    Hemiplegia: Hysterical

    • Description: Patient exhibits paralysis in the absence of an organic pyramidal lesion.

    Hemiplegia: Causes

    • Vascular causes: Most common
      • Thrombotic: Cerebral infarction.
        • Cerebral atherosclerosis
        • Vasculitis
        • Blood diseases causing hyperviscosity
        • Circulation diseases (slow circulation): Heart failure, systemic hypotension
      • Embolic: Cerebral infarction
        • Heart (most common): Mitral stenosis with atrial fibrillation
        • Distal vessels: Deep venous thrombosis
        • Rare sources: Lungs or bones
      • Hemorrhagic: Intracranial hemorrhage
        • Intracerebral: Bleeding within the brain substance, may leak into ventricles. Can compress vital centers. The middle cerebral artery is commonly affected.
        • Subarachnoid: Bleeding in the subarachnoid space
        • Subdural or extradural: Blood often forms a hematoma.

    Hemiplegia: Causes of Intracranial Hemorrhage

    • Hypertension: Most common cause of intracranial hemorrhage.
    • Rupture of intracranial aneurysm, angioma, or A-V malformation: Most common cause of subarachnoid hemorrhage.
    • Hemorrhagic blood diseases: Hemophilia
    • Anticoagulants
    • Trauma to the head: Most common cause of subdural hemorrhage

    Hemiplegia: Diagnosis

    • Confirmed diagnosis through CT and MRI scans.

    Hemiplegia: Variability in Clinical Picture

    • The clinical picture of hemiplegia can vary significantly depending on:
      • The cause of the lesion
      • The site of the lesion
      • The time course of onset

    Hemiplegia: Clinical Picture Variations: Cause of Lesion

    • Vascular causes: It's crucial to differentiate the clinical picture in thrombotic, embolic, and hemorrhagic lesions.

    Hemiplegia: Clinical Picture Variations: Site of Lesion

    • The lesion causing hemiplegia can occur at three main levels:
      • Spinal cord: Lesion on one side of the cord between C1 and C5 segments, often caused by stab wounds, disc prolapse, or tumor. This leads to Brown-Sequard syndrome.
      • Brain stem: Lesion on one side of the brain stem resulting in crossed hemiplegia.
      • Cerebral: Lesion can occur in the cortex, subcortex, or internal capsule.

    Hemiplegia: Brown-Sequard Syndrome

    • Description: Characterized by:
      • Ipsilateral hemiplegia
      • Ipsilateral deep sensory loss
      • Contralateral superficial sensory loss (pain and temperature)

    Hemiplegia: Crossed Hemiplegia

    • Description: Characterized by:
      • Hemiplegia on the opposite side of the lesion
      • Cranial nerve paralysis of LMN nature on the same side of the lesion

    Hemiplegia: Cerebral Lesion

    • Description:
      • Cortical: May be associated with one or more of the following symptoms:
        • Coma if the lesion is extensive
        • Convulsions if the lesion is irritative
        • Contralateral cortical sensory loss if the parietal lobe is involved
        • Aphasia and agraphia if the lesion is in the dominant hemisphere
      • Subcortical: Similar to cortical hemiplegia but with more extensive paralysis.
      • Capsular: Characterized by:
        • Complete hemiplegia associated with UMN facial and hypoglossal paralysis on the opposite side of the lesion
        • Hemi-hyposthesia on the opposite side of the lesion
        • No convulsions, aphasia, or coma.

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    Description

    Test your knowledge on the onset, course, and symptoms of hemiplegia. This quiz covers acute and progressive types, along with specific signs associated with the condition. Perfect for students in medical fields or anyone interested in neurological disorders.

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