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1. CLINICAL FEATURES OF
HEMIPLEGIA

2. HEMIPLEGIA
• Weakness of one half of body with or
without involvement of face
• PRESENTATION OF
UNILATERAL LESION
ABV C5 LEVEL OF
SPINAL CORD

3. • How was the onset and how did it progress???

4. ONSET AND PROGRESS
• THROMBOTIC
• EMBOLIC
• HEMORRHAGIC

5. THROMBOTIC STROKE
• Onset during sleep or on rising
• Usually in elderly
• Stepwise evolution
• Preservation of consiousness
• Gradual recovery

6. • No seizure or headache
• h/o prodromal TIA’s
• Evidence of atheroscelerosis

7. EMBOLIC
• Abrupt development of completed
stroke within few seconds
• Rapid improvement within minutes or
hours
• Occur at any time
• Relative preservation of consiousness
• Occur in any age

8. • Localised headache,seizures +
• Rapid recovery
• Evidence of recent stroke
• No history of prodromal TIA

9. HEMORRHAGIC
• Presence of hypertension
• Onset during walking hours
• Headache +/_ , seizure+ , vomiting +
• Deepening stupor/ coma
• Gradual development

10. • Nuchal rigidity
• Delayed or no recovery
• Absence of prodromal symptoms

11. • LOCALIZATION ????

12. PYRAMIDAL TRACT
UMN LMN
• Weakness in the • Weakness in the spinal
corticospinal dist segment dist
• Distal muscle groups • Wasting
• Axial movts are spared
• Extraocular,upper
facial,pharyngeal,jaw
muscles are spared

13. • Hypertonia • Hypotonia
• Exaggrated tendon • Loss of tendon reflex
reflex • Muscle wasting
• No muscle wasting • Fasciculation &
• Extensor plantar contracture of affected
response muscle
• Loss of abdominal • Trophic changes in skin
reflexes nail

14. What the patient complaints off ????
• Stiffness of legs
• Unable to walk on rough ground
• Diff.to climb stairs
• Vibration of limb while stepping down
the stairs- ankle conus
• Finally,dragging of foot,stiff legged
gait,keeps tripping over,shoes wearing
off

15. Features of
extrapyramidal lesion
• Difficulty to initiate voluntary movt
• Hypertonia-rigidity
• No loss of power of muscles
• Bradykinesia
• Inv movts
• Postural instability

16. Associated features

17. • Headache and vomiting
• Altered level of consiousness
• Seizure
• Speech abnormality
• Altered behaviour
• Bowel and bladder involvement

18. Cerebellar symptoms
• Wide based gait
• Scanning speech
• Nystagmus,tendency to fall
• Weakness due to hypotonia(pendular
knee jerk)
• Dysdiadocokinesis
• Dysmetria
• Intention tremor

19. POSTERIOR TRACT
INV
• Diff.to stand ,walk
• Positive rombergs sign
• Stamping gait
• Unable to walk in dark

20. cranial nerve involvement