1
CLINICAL EXAMINATION IN HEMIPLEGIA
I.INTRODUCTION
Hemiplegia is paralysis of one half of the body-which includes arm, leg and often face on the
affected side.
Terms used to describe weakness
Hemiplegia: Total Paralysis on one side of the body
Hemiparesis: Weakness on one side of the body.
MAIN POINTS: (Hemiplegia)
• Usually acute in onset
• Results from upper motor lesion/ most commonly pyramidal tract lesion
• Associated symptoms and signs aid the diagnosis of level of the lesion
• A detailed history taking is of great value
• Initially -weakness is flaccid; later-spastic
• Diagnostic Features:
Involvement of one half of the body, hypertonia, hyper-reflexia, extensor
plantar- response and characteristic hemiplegic gait.
• Speedy reach to hospital at the earliest warning signs is a must.
• Treatment of risk factors- ideal for prevention
• Refer chart 1 below
Contents
Introduction
Clinical examination Sensory system
Main points
General examination Reflexes-deep+superficial
History elicitation
Higher functions
Examination of extrapyramidal system
Present and past history
Cranial nerves
Eamination of cerebellar system
Family and personal history Spinal motor system Other systems
II. Points of importance in
HISTORY
1. Presenting symptoms
• Motor symptoms
Decreased movements- Paresis /paralysis
Increased movements; involuntary movements
Feeling of stiffness or flailness
• Sensory symptoms
Reduced sensations – hypoesthesia /anesthesia
Increased sensation – occurs in
Thalamic pain –where threshold for pain is increased9Hyperpathia)
-it is a boring, diffuse, unpleasant and spontaneous pain
- Exacerbated by touch of clothing
• H/o Higher function disorders
Altered consciousness
Speech disturbance
• cranial nerve Disorders
Especially VII cranial nerve
to UMN lesion
• Pearls for practice:
USUALLY ACUTE IN
ONSET
ASSOCIATED
SYMPTOMS A