Etiology of hemiplegia

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1. ETIOLOGY OF HEMIPLEGIA

2. CAUSES OF HEMIPLEGIA STROKE CNS INFECTION- MENINGITIS, ENCEPHALITIS DEMYELINATION- MULTIPLE SCLEROSIS , POST INFECTIOUS TRAUMA HEMIPLEGIC MIGRAINE TODD’S PARALYSIS VASCULITIS

3. STROKE ACUTE STROKE _RAPID APPEARANCE OF A FOCAL DEFICIT OF BRAIN FUNCTION , WITH OR WITHOUT SIGNS OF FOCAL HIGHER CEREBRAL DYSFUNCTION , HEMISENSORY LOSS, VISUAL FIELD DEFECT OR BRAIN STEM DEFECT MEDICAL EMERGENCY

4. TERMS RELATED TRANSIENT ISCHEMIC ATTACK – RESOLVE WITHIN 24 HRS STROKE- LAST MORE THAN 24 HRS STROKE IN EVOLUTION- FND PROGRESSING COMPLETED STROKE-FND PERSISTS –NOT PROGRESSING

5. CAUSES OF STROKE CEREBRAL INFARCTION PRIMARY INTRACEREBRAL HAEMORRHAGE SUB ARACHNOID HAEMORRHAGE

6. PATHOPHYSIOLOGY CEREBRAL INFARCTION CARDIAC EMBOLISM - MCA PCA ATHEROSCLEROSIS – CAROTID ARTERY ARTERIAL DISSECTION NEUROSYPHILIS THROMBOPHILIA VASCULITIS HOMOCYSTINURIA SLE APLA SYNDROME SICKLE CELL ANAEMIA - CHILDREN

7. RISK FACTORS FIXED MODIFIABLE AGE HYPERTENSION GENDER HEART DISEASE HEREDITY , RACE DM HYPERLIPIDEMIA MI STROKE SMOKING ALCOHOL OCP HIGH FIBRINOGEN POLYCYTHEMIA

8. CEREBRAL INFARCTION Occlusion of cerebral artery opening of anastomotic channels perfusion restored Homeostatic mech fail ischemia & infarction neuronal functions fail neurological deficit

9. Infarction (Continued) Ischemia persists _ hypoxia _ inadequate ATP supply _ failure of membrane pumps_ influx of Na & water _ cytotoxic edema_glutamate release _ influx of Na & Ca_ enzyme activation _ irreversible cell death Lactic acid accumln & fall in pH

10. PRIMARY INTRACEREBRAL HAEMORRHAGE ARTERIOVENOUS MALFORMATION DRUG MISUSE- AMPHETAMINE , COCAINE COAGULOPATHY Rupture of blood vessel within brain parenchyma _ explosive entry of blood _ structural disruption of neurons_ progression of neurological deficit

11. CAUSES & RISK FACTORS COMPLEX SMALL VESSEL DISEASE N VESSEL WALL DISRUPTION AGE HT AMYLOID ANGIOPATHY FAMILIAL AGE IMPAIRED BLOOD CLOTTING ANTICOAGULANT THERAPY , BLOOD DYSCRASIA VASCULAR ANOMALY AV MALFORMATION CAVERNOUS HEMANGIOMA SUBSTANCE MISUSE ALCOHOL AMPHETAMINE COCAINE

12. SUB ARACHNOID HAEMORRHAGE LESS COMMON – WOMEN MORE AFFECTED Saccular aneurysm AVM Vertebral dissection Berry aneurysm- region of circle of Willis First degree relatives Polycystic kidney disease Ehlers Danlos Syn Non aneurysmal haemorrhage ( peri-mesencephalic haemorrhage )

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