Hemiparesis is the incomplete paralysis of one half of the body. This is a symptom of a serious underlying disease and is caused by damage to the opposite side of the brain. If symptoms of paralysis occur, a doctor must be consulted immediately.
What is hemiparesis?
Therapy for hemiparesis is primarily aimed at restoring and maintaining the patient’s independence through various exercises. Hemiparesis can affect people of all ages. The causes are varied and can lead to paralysis of the arms, legs or the muscles of the face, tongue and mouth. Hemiparesis always results from damage to the brain. If the left side of the brain is affected by a disease, the paralysis occurs in the right side of the body. If, on the other hand, the right side of the brain is damaged, the muscles in the left side of the body are paralyzed. The more severe and persistent the disorder and the larger the affected brain area, the more pronounced the symptoms. Movement disorders, the development of spasticity, reduced sensitivity to touch and pain, or, in the worst case, severe mental disorders can be the result of hemiparesis.
Causes
The most common cause of hemiparesis is a lack of oxygen to the brain. This can be caused by a circulatory problem in the blood vessels or bleeding into the brain. If the cerebral cortex is damaged as a result, the impulses responsible for movement are no longer transmitted without interference from the brain via the spinal cord to the nerves. A stroke not only occurs in old adulthood, but can also affect children. In addition to the hemiparesis, visual and speech disorders as well as dizziness and sometimes severe headaches are often observed. Other causes of hemiparesis can be accidental injuries to the brain, inflammatory diseases such as meningitis or encephalitis or, more rarely, tumors in the brain. In these cases, paralysis does not occur suddenly but develops over hours, days, or even weeks.
Symptoms, complaints, and signs
Hemiparesis is manifested primarily by restricted movement on the left or right side of the body. Muscle tension is either too weak or too strong on the paretic (paralyzed) side. As a result, the affected person can no longer move as usual. His movements are either uncoordinated or overshooting. It is often possible to stand or walk despite paresis (incomplete paralysis), while the affected arm can hardly be used. Despite the ability to stand up and move around alone or with assistance, many hemiplegics have balance or coordination problems. Hemiparesis, or hemiplegia, usually affects the facial muscles, allowing saliva to drip from the corner of the mouth without the affected person noticing. Even when smiling, the corners of the mouth cannot be raised symmetrically. It is therefore not surprising that speech disorders can occur. Some patients unfortunately suffer from double vision because the muscles that move the affected eyeball are partially paralyzed. Occasionally, sensory disturbances occur. In this case, surfaces, temperatures or objects are perceived inaccurately. For example, the affected person may not feel hot soup running over his hand. The appearing burn blisters, he can not explain later.
Diagnosis and course
Since hemiparesis is only a symptom and not a disease in its own right, the cause must first be determined in order to initiate successful therapy. The neurologist can draw conclusions about the underlying disease on the basis of the respective medical history and the temporal occurrence of the paralyses (sudden in the case of strokes and cerebral hemorrhages, gradual in the case of inflammations and tumors). In a neurological examination, the cranial nerves, reflexes, sensitivity to touch and strength in the arms and legs are checked. In addition, an examination of the carotid artery and an assessment of the tension state of the neck are performed. To visualize pathological changes in the brain, the neurologist uses imaging techniques such as computed tomography, magnetic resonance imaging (MRI) or angiography to clarify hemiparesis.
Complications
Associated with hemiparesis, various complications may occur.Hemiplegia can initially lead to emaciation and frailty, often accompanied by severe motor disturbances of the entire body. The internal and external organs may also be affected and damaged in various ways as the disease progresses. In mild cases, the sense of balance decreases due to paralysis, and mobility impairments occur. In severe cases, there is pneumonia and thrombosis in the paralyzed limbs and impairment of the excretory organs, also accompanied by a number of other complications. In addition, in the context of hemiparesis, intellectual performance may decrease. Depending on the severity of the paralysis, inflammation of the joints is also conceivable. Further complications occur due to possible bed confinement: ulcers (decubitus), urinary tract infections and contractures, joint stiffness, muscle atrophy and epilepsies occur. Hemiparesis can also lead to blood clots and severe pain in the affected areas of the body due to the paralysis that occurs and the associated circulatory problems. As a consequence, a stroke or a spreading of the disease may occur. Whether and to what extent these secondary symptoms occur depends on the severity of the hemiparesis and the treatment of the underlying disease. Early treatment can usually prevent serious complications.
When should you see a doctor?
If hemiparesis occurs, a doctor must be seen immediately. In the worst case, the paralysis can remain permanent and then not be treated. Early diagnosis always has a positive effect on the further course of the disease. The doctor should be consulted for hemiparesis when severe paralysis occurs suddenly and without any particular reason. In most cases, paralysis also occurs in the face. Affected persons also suffer from disturbances in movement and coordination and thus from significant limitations in their everyday life. Visual disturbances or speech disorders also indicate the disease and should always be examined by a doctor if they occur suddenly and do not disappear again on their own. This can prevent the permanent occurrence of these disorders. Examination and treatment can be done by a neurologist. In acute emergencies or severe symptoms, the hospital may also be visited. Further treatment usually depends on the exact cause of the hemiparesis and the patient’s capabilities.
Treatment and therapy
Therapy for hemiparesis is primarily aimed at restoring and maintaining the patient’s independence through various exercises. In this context, treatment depends crucially on the underlying disease in question. If a stroke is the cause of the paralysis symptoms, the patient is immediately administered anticoagulants. In the case of bleeding, surgery is usually required to prevent spread to the surrounding tissue. Hemiparesis caused by meningitis or encephalitis, is controlled by the administration of antibiotics or viral drugs. A tumor may be surgically removed. In addition, chemotherapy and/ or radiation therapy may be necessary. After acute treatment, the patient usually receives a rehabilitation program consisting of physical, occupational and speech therapy as a second step. To combat paralysis in the extremities, the use of orthoses is suitable. Botulinum toxin treatments or surgery are also promising. Another approach is forced use therapy, in which the healthy limbs are immobilized to encourage the patient to use the paralyzed extremities. Often, hemiparesis is accompanied by severe anxiety. Therefore, psychotherapy is recommended.
Outlook and prognosis
A distinction must be made between people who already had hemiparesis at birth and people in whom the condition occurs as a result of a stroke. For the first group, there is no cure. Although therapies show how to cope with everyday life, help remains necessary throughout life. The second group may improve, but this depends on certain conditions. Hemiplegia after a stroke leads to differentiated chances of recovery. Basically, the probability of recovery increases when patients are still quite young and the severity is low.With individual therapy, movement disorders can be minimized. Nerve areas can then be remodeled. However, the effort is great. Regression can take months and years. Other people may improve their sensation, but they remain dependent on help for life. Sufferers can take steps themselves to improve their prognosis. Scientific evidence shows that alcohol and cigarettes are counterproductive to recovery. Instead, patients should eat a healthy, balanced diet. Existing excess weight should be reduced. Exercise should be done within reason.
Prevention
Because hemiparesis is triggered in most cases by a stroke, it is important to combat risk factors such as high blood pressure or calcification of the vessels. A healthy lifestyle with a balanced diet and sufficient exercise avoids obesity and makes a decisive contribution to maintaining good health. If the blood vessels are already narrowed by deposits or if there are cerebral circulatory disorders, the administration of medication is a must.
Follow-up care
Depending on the cause of the hemiparesis, different follow-up measures are necessary. If the hemiparesis was based on a tumor, chemotherapy or radiation therapy is often given during follow-up. If the hemiparesis was caused by a blood clot (thrombosis), doctors prescribe medication to thin the blood. These have a preventive effect and prevent the formation of further thromboses. To restore the greatest possible mobility to the paralyzed muscles, physiotherapy is an integral part of effective aftercare. Through special movement exercises, the patient should be given back a high degree of independence. The earlier and more intensive physiotherapy begins, the more effective the recovery of the paralyzed body regions can be. However, complete recovery is rarely possible. If the hemiparesis has also affected the facial muscles, speech therapy is also part of the aftercare. The goal is to increase speech intelligibility. If spasms persist despite physiotherapy or speech therapy, Botox is sometimes used to relax the muscles. This relieves spasmodic episodes. Often, after a hemiparesis, the patient must also prove his or her fitness to drive in the course of an assessment, since failure symptoms may have occurred as a result of the hemiparesis. Since hemiparesis is accompanied by a high degree of psychological stress in addition to the physical limitations, accompanying psychotherapy often takes place.
What you can do yourself
Direct self-help or possibilities for self-treatment are usually not possible with hemiparesis. The disease can also only be partially prevented by the affected person leading a healthy lifestyle. This includes a healthy diet and also sufficient exercise. Above all, overweight should be avoided in order not to trigger hemiparesis. Since the affected person suffers from severe paralysis and thus restrictions in their life with this disease, they are dependent on the help of family and friends. Loving and patient care has a very positive effect on the course of the disease and can possibly also alleviate or prevent psychological complaints. In many cases, it is also worthwhile to contact other affected persons or a psychologist in order to talk about the possible course of the disease. In doing so, possible feelings of anxiety can also be resolved. Especially in the case of children, detailed discussions about the consequences of hemiparesis are necessary. Since the patient’s sense of balance is also negatively affected by the disease, they should use walking aids to avoid further injury. In the event of an epileptic seizure, an emergency physician should be notified immediately. The affected person should be placed in a stable lateral position and reassured until the ambulance arrives.
