Hemiplegia Health Dictionary

Paralysis, or PALSY, is loss of muscular power due to some disorder of the NERVOUS SYSTEM. Weakness – rather than total movement loss – is sometimes described as paresis. Paralysis may be temporary or permanent and may be accompanied by loss of feeling.

Paralysis due to brain disease The most common form is unilateral palsy, or HEMIPLEGIA, generally arising from cerebral HAEMORRHAGE, THROMBOSIS or EMBOLISM affecting the opposite side of the BRAIN. If all four limbs and trunk are affected, the paralysis is called quadraplegia; if both legs and part of the trunk are affected, it is called paraplegia. Paralysis may also be divided into ?accid (?oppy limbs) or spastic (rigid).

In hemiplegia the cause may be an abscess, haemorrhage, thrombosis or TUMOUR in the brain. CEREBRAL PALSY or ENCEPHALITIS are other possible causes. Sometimes damage occurs in the parts of the nervous system responsible for the ?ne control of muscle movements: the cerebellum and basal ganglion are such areas, and lack of DOPAMINE in the latter causes PARKINSONISM.

Damage or injury Damage to or pressure on the SPINAL CORD may paralyse muscles supplied by nerves below the site of damage. A fractured spine or pressure from a tumour may have this e?ect. Disorders affecting the cord which can cause paralysis include osteoarthritis of the cervical vertebrae (see BONE, DISORDERS OF), MULTIPLE SCLEROSIS (MS), MYELITIS, POLIOMYELITIS and MENINGITIS. Vitamin B12 de?ciency (see APPENDIX 5: VITAMINS) may also cause deterioration in the spinal cord (see also SPINE AND SPINAL CORD, DISEASES AND INJURIES OF).

Neuropathies are a group of disorders, some inherited, that damage the peripheral nerves, thus affecting their ability to conduct electrical impulses. This, in turn, causes muscle weakness or paralysis. Among the causes of neuropathies are cancers, DIABETES MELLITUS, liver disease, and the toxic consequences of some drugs or metals – lead being one example.

Disorders of the muscles themselves – for example, muscular dystrophy (see MUSCLES, DISORDERS OF – Myopathy) – can disturb their normal working and so cause partial or complete paralysis of the part(s) affected.

Treatment The aim of treatment should be to remedy the underlying cause – for example, surgical removal of a displaced intervertebral

disc or treating diabetes mellitus. Sometimes the cause cannot be recti?ed but, whether treatable or not, physiotherapy is essential to prevent joints from seizing up and to try to maintain some tone in muscles that may be only partly affected. With temporary paralysis, such as can occur after a STROKE, physiotherapy can retrain the sufferers to use their muscles and joints to ensure mobility during and after recovery. Patients with permanent hemiplegia, paraplegia or quadraplegia need highly skilled nursing care, rehabilitative support and resources, and expert help to allow them, if possible, to live at home.... paralysis

Muscular weakness or partial paralysis affecting only 1 side of the body (see hemiplegia).... hemiparesis

DC.

Synonym: A. officinarum Hayne

Family: Compositae; Asteraceae.

Habitat: Native to the Mediterranean region; cultivated in Algeria.

English: Spanish, Pellitory, Pyrethrum Root.

Ayurvedic: Aakaarakarabha, Aakallaka, Aakulakrit, Agragraahi.

Unani: Aaqarqarhaa.

Siddha/Tamil: Akkiraakaaram.

Action: Stimulant, cordial, rubefa- cient.A gargle of infusion is prescribed for relaxed vulva. Root— used for toothache, rheumatic and neuralgic affections and rhinitis. Roots, along with the root of Witha- nia somnífera and Vitis vinifera, are used in epilepsy.

Along with other therapeutic applications, Ayurvedic Pharmacopoeia of India indicates the use of the root in sciatica, paralysis, hemiplegia and amenorrhoea.

The root contains anacycline, isobu- tylamide, inulin and a trace ofessential oil.

The local anaesthetic activity of the alcoholic (2%) extract of the root was found to be comparable to that of xy- locaine hydrochloride (2%) in dental patients.

Use of the drug in patients with insulin-dependent diabetes mellitus reduces the dose of insulin. It decreased the plasma glucose and serum cholesterol levels after oral administration for 3-6 weeks. (The plant is mixed with Helleborus nigar in a ratio of 1:3.) The plant extract inhibited tobacco-induced mutagenesis by 47.5% at a concentration of 1 mg/plate.

Dosage: Root—500 mg to 1 g powder. (CCRAS.)... anacyclus pyrethrum

Dymock.

Family: Fabaceae; Papilionaceae.

Habitat: The mountainous regions from Asia Minor to Iraq and Iran.

English: Sarcocola.

Ayurvedic: Rudanti (substitute).

Unani: Anzaroot, Kohal Kirmaani (Gum).

Action: Gum—antirheumatic, aperient, anthelmintic, emollient.

The rootbark yields alkaloids, atala- phylline and its N-methyl derivatives and atalaphyllidine, which have close structural similarities with the antitu- mour alkaloid, acronycine, and its co- geners. The rootbark also contains the limonoid, atalantin.

The leaf juice forms an ingredient of a compound liniment used in hemiplegia. The essential oil is used in paralysis. The oil contains higher terpene esters belonging to azulene group (29%). (Azulenes impart anti-inflammatory activity.)... astragalus sarcocola

(L.) Benth.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India; up to 1,800 m in the western Himalayas.

Ayurvedic: Vana-kulattha.

Folk: Jangli Tur, Kulthi.

Action: Antidysenteric, anticholerin, febrifuge; also used in anaemia, anasarca and hemiplegia. Seeds— taeniafuge.

A flavone glucoside, atyloside, has been isolated from the leaves.... atylosia scarabaeoides

Hook. ex Stocks

Synonym: Commiphora mukul (Hook. ex Stocks) Engl. C. wightii (Arn.) Bhandari.

Family: Burseraceae.

Habitat: Rajasthan, Madhya Pradesh, Assam, Andhra Pradesh, Karnataka.

English: Indian Bdellium, Gum Guggul.

Ayurvedic: Guggul, Devadhoop, Kaushika, Pur, Mahishaaksha, Palankash, Kumbha, Uluukhala.

Unani: Muqallal yahood, Muql, Bu-e-Jahudaan

Siddha/Tamil: Erumaikan Kungiliyam.

Action: Oleo-gum-resin—used for reducing obesity and in rheumatoid arthritis, osteoarthritis, sciatica.

Key application: In the treatment of hyperlipidemia, hypercholestero- laemia and obesity. (WHO.)

Guggulipid is hypocholesteremic. Guggul resin contains steroids—gug- glsterones Z and E, guggulsterols IV, diterpenoids; volatile oil, including other constituents, contains a terpene hydrocarbon cembrene A. E- and Z- guggulsterones are characteristic constituents, which distinguish C. mukul from other Commiphore sp.

Guggul resin increases catechola- mine biosynthesis and activity in cholesterol-fed rabbits, inhibits platelet aggregation, exhibits anti-inflammatory activity and appears to activate the thyroid gland in rats and chicken. Z- guggulsterone may increase uptake of iodine by thyroid gland and increase oxygen uptake in liver and bicep tissues. (Planta Med 1984,1, 78-80.)

The gum is also used in hemiplegia and atherosclerotic disorders; as a gargle in pyrrhoea aveolaris, chronic tonsilitis and pharyngitis. Fumes are recommended in hay fever, chronic bronchitis and nasal catarrh.

Oleo-gum resin of Balsamodendron caudatum is also equated with Guggul in Siddha medicine.

Dosage: Oleo-gum-resin—2-4 g (API Vol. I.) 500 mg to 1 g (CCRAS.)... balsamodendron mukul

n. failure to be aware of one’s disability, often resulting from right hemisphere brain damage. It is seen with a range of deficits, including *hemiplegia and *hemispatial neglect. A striking example is Anton’s syndrome, in which patients believe they can see normally despite being completely blind following severe bilateral damage to the visual cortex.... anosognosia

(Kernohan’s syndrome) *hemiplegia that is *ipsilateral to the brain lesion that caused it, due to pressure of the lesion (which is often a haematoma) on surrounding structures in the brain. It is unusual because normally a lesion of the brain causes dysfunction in the *contralateral limbs. [J. W. K. Kernohan (20th century), US pathologist]... kernohan’s phenomenon

Linn.

Family: Calsalpiniaceae.

Habitat: Throughout India as a weed.

English: Sickle Senna, Ringworm Plant.

Ayurvedic: Chakramarda, Chakri, Prapunnaada, Dadrughna, Me- shalochana, Padmaata, Edagaja.

Unani: Penwaad Taarutaa.

Siddha/Tamil: Ushittgarai.

Folk: Chakavad, Daadamaari.

Action: Leaves—taken internally to prevent skin diseases; applied against eczema and ringworm; pounded and applied on cuts, act like tincture of iodine. Seeds, soaked in water, are taken for spermatorrhoea. A paste made of equal parts of leaves and seeds is given for jaundice. Pods are used in dysentery.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicated the use of the seed in paralysis and hemiplegia as a supporting drug.

The leaves contain chrysophanol, aloe-emodin, rhein and emodin. Mature leaves possess purgative properties and are sometimes utilized to adulterate the true senna; also used as an antiperiodic and anthelmintic.

The leaf extract exhibited antifungal activity against the ringworm fungus Microsporon nanum.

Seeds contain anthraquinone glyco- sides, naptho-pyrone glycosides, cas- siaside and rubrofusarin-6-beta-genti- obioside. These constituents showed significant hepatoprotective activity.

Thrachrysone, isolated from seeds, showed stronger antioxidant activity than tocopherol and BHA.

Chrysophanic acid-9-anthrone, extracted from the seed, was found to be active against ringworm fungi.

Dosage: Seed—1-3 g powder. (API Vol. III.)... cassia tora

The term used to describe a group of conditions characterised by varying degrees of paralysis and originating in infancy or early childhood. In some 80 per cent of cases this takes the form of spastic paralysis (muscle sti?ness), hence the now obsolete lay description of sufferers as ‘spastics’. The incidence is believed to be around 2 or 2·5 per 1,000 of the childhood community. In the majority of cases the abnormality dates from well before birth: among the factors are some genetic malformation of the brain, a congenital defect of the brain, or some adverse e?ect on the fetal brain as by infection during pregnancy. Among the factors during birth that may be responsible is prolonged lack of oxygen such as can occur during a di?cult labour; this may be the cause in up to 15 per cent of cases. In some 10–15 per cent of cases the condition is acquired after birth, when it may be due to KERNICTERUS, infection of the brain, cerebral thrombosis or embolism, or trauma. Acute illness in infancy, such as meningitis, may result in cerebral palsy.

The disease manifests itself in many ways. It may not be ?nally diagnosed and characterised until the infant is two years old, but may be apparent much earlier – even soon after birth. The child may be spastic or ?accid, or the slow, writhing involuntary movements known as athetosis may be the predominant feature. These involuntary movements often disappear during sleep and may be controlled, or even abolished, in some cases by training the child to relax. The paralysis varies tremendously. It may involve the limbs on one side of the body (hemiplegia), both lower limbs (paraplegia), or all four limbs (DIPLEGIA and QUADRIPLEGIA). Learning disability (with an IQ under 70) is present in around 75 per cent of all children but children with diplegia or athetoid symptoms may have normal or even high intelligence. Associated problems may include hearing or visual disability, behavioural problems and epilepsy.

The outlook for life is good, only the more severely affected cases dying in infancy. Although there is no cure, much can be done to help these disabled children, particularly if the condition is detected at an early stage. Assistance is available from NHS developmental and assessment clinics, supervised by community paediatricians and involving a team approach from experts in education, physiotherapy, occupational therapy and speech training. In this way many of these handicapped children reach adulthood able to lead near-normal lives. Much help in dealing with these children can be obtained from SCOPE (formerly the Spastics Society), and Advice Service Capability Scotland (ASCS).... cerebral palsy

combining form denoting paralysis. Example: hemiplegia (of one side of the body).... plegia

Linn.

Synonym: D. fastuosa Linn.

Family: Solanaceae.

Habitat: Throughout India, particularly in waste place.

English: Thornapple, Downy Datura.

Ayurvedic: Dhattuura, Dhuurta, Dhastura, Unmatta, Shivapriya, Harapriya, Hema, Haatta, Dhustuu- ra, Dhustuuraka, Kanaka, Maatula. Also equated with Raaj-dhatuura. (white var.)

Unani: Dhaturaa.

Siddha/Tamil: Oomatthai, Karu- voomatthai.

Action: Various plant parts are used in headache, hemiplegia, epilepsy, delirium, convulsions, cramps, rigid thigh muscles, rheumatism. Leaf— antitumour, antirheumatic. Leaf and corolla—anti-inflammatory. Flower—antiasthmatic. Seed, leaf and root—anticatarrhal, febrifuge, antidiarrhoeal, antidermatosis; also used in cerebral complications. Seeds—used in asthma. Limited use in kinetosis (excessive salivation, nausea and vomiting).

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia ofIndia indicated the use of the whole plant in dysuria and alopecia.

The plant accumulates more hyos- cine than hyoscyamine. Hyoscine content of dried leaves and flowering tops—between 0.02-0.55%. Alkaloid content of leaves—0.55%; stem—0.4%; seeds—0.19%; pericarps—0.8%; root at flowering of the plant—0.77%.

Hyoscine in large doses causes delirium and coma.

Dosage: Seed—30-60 mg. (API Vol. III.)... datura metel

The way in which an individual walks. Gait may be affected by inherited disorders; by illness – especially neurological disorders; by injury; or by drug and alcohol abuse. Children, as a rule, begin to walk between the ages of 12 and 18 months, having learned to stand before the end of the ?rst year. If a normal-sized child shows no ability to make movements by this time, the possibility of mental retardation must be borne in mind, and if the power of walking is not gained by the time the child is a year and a half old, RICKETS, CEREBRAL PALSY, or a malformation of the hip-joint must be excluded.

In hemiplegia, or PARALYSIS down one side of the body following a STROKE, the person drags the paralysed leg.

Steppage gait occurs in certain cases of alcoholic NEURITIS, tertiary SYPHILIS (tabes) and other conditions where the muscles that raise the foot are weak so that the toes droop. The person bends the knee and lifts the foot high, so that the toes may clear obstacles on the ground. (See DROP-FOOT.)

In LOCOMOTOR ATAXIA or tabes dorsalis, the sensations derived from the lower limbs are blunted, and consequently the movements of the legs are uncertain and the heels planted upon the ground with unnecessary force. When the person tries to turn or stands with the eyes shut, he or she may fall over. When they walk, they feel for the ground with a stick or keep their eyes constantly ?xed upon it.

In spastic paralysis the limbs are moved with jerks. The foot ?rst of all clings to the ground and then leaves it with a spasmodic movement, being raised much higher than is necessary.

In PARKINSONISM the movements are tremulous, and as the person takes very short steps, he or she has the peculiarity of appearing constantly to fall forwards, or to be chasing themselves.

In CHOREA the walk is bizarre and jerky, the affected child often seeming to leave one leg a step behind, and then, with a screwing movement on the other heel, go on again.

Psychologically based idiosyncracies of gait are usually of a striking nature, quite di?erent from those occuring in any neurological conditions. They tend to draw attention to the patient, and are worse when he or she is observed.... gait

Burm. f.

Synonym: Gendarussa vulgaris Nees.

Family: Acanthaceae.

Habitat: Throughout the greater part of India and Andaman Islands.

Ayurvedic: Krishna Vaasaa (blue var.), Nila-nirgundi, Krishna- nirgundi, Nila-manjari.

Siddha/Tamil: Karunochhi, Vadaikkuthi.

Action: Febrifuge, diaphoretic, emetic, emmenagogue. Infusion of leaves—given internally in cephalal- gia, hemiplegia and facial paralysis. Fresh leaves—used topically in oedema and rheumatism. Bark— emetic.

The leaves contain beta-sitosterol, an alkaloid, lupeol, friedelin and aromatic amines.... justicia gendarussa

(Linn.) Hallier. f.

Synonym: Convolvulus tridentatus Linn.

Ipomoea tridentata (L.) Roth.

Family: Convolvulaceae.

Habitat: Upper Gangetic Plain, Bihar, Orissa, West Bengal, South India and Gujarat.

Ayurvedic: Prasaarini (Kerala and Karnataka), Tala-nili.

Siddha/Tamil: Mudiyaakunthal.

Action: Laxative, astringent, anti-inflammatory. Used in piles, swellings, rheumatic affections, stiffness of the joints, hemiplegia and urinary affections.

The aerial parts contain the flavo- noids, diometin, luteolin and their 7- O-beta-D-glucosides.... merremia tridentata

Linn. f.

Family: Anacardiaceae.

Habitat: Punjab, Assam, Khasi Hills, Madhya Pradesh and Peninsular India.

English: Marking-Nut.

Ayurvedic: Bhallaataka, Bhallata, Arushkara, Agnik, Agnimukha, Sophkrit, Viravrksha.

Unani: Balaadur, Bhilaayan, Bhilaavaan.

Siddha/Tamil: Shenkottei, Erimugi. (Kattu shen-kottai is equated with S. travancorica Bedd., found in evergreen forests of Tinnevelly and Travancore.)

Folk: Bhilaavaa.

Action: Toxic drug, used only after curing. Fruit—caustic, astringent, anti-inflammatory, antitumour. Used in rheumatoid arthritis and for the treatment of tumours and malignant growths.

A decoction, mixed with milk or butter fat, is prescribed in asthma, neuralgia, sciatica, gout, hemiplegia, epilepsy. Kernel oil—antiseptic; used externally in gout, leucoderma, psoriasis and leprosy. Bark gum—used for nervous debility; in leprous, scrofulous and venereal affections.

Bigger var. is equated with S. kurzii Engler.

The nut shells contain biflavonoids, including tetrahydrobustaflavone, tet- rahydroamentoflavone and anacardu- flavanone; nallaflavone; anacardic acid; aromatic amines and bhilawanol. Bhi- lawanol is a mixture of phenolic compounds, including cis and trans isomers of urushenol (3-pentadecenyl-8' catechol), monohydroxy phenol and semicarpol. These are the major constituents of the shell liquid, isolated from the nuts (about 46% of the weight of extract).

A mixture of closely related pentade- cyl catechols exhibits anticancer activity. Extracts of the fruit was found effective against human epidermoid carcinoma of the naso-pharynx in tissue culture.

Milk extract of the nut showed anti-inflammatory activity against car- rageenin, 5-HT and formaldehyde- induced rat paw oedema in acute anti- inflammatory studies. (About 20% animals developed gangrene of limbs, tail and ears.)

Dosage: Detoxified fruit—1-2 g in milk confection. (API, Vol. II.)... semecarpus anacardium

Linn.

Family: Malvaceae.

Habitat: Throughout India in moist places.

English: Country Mallow.

Ayurvedic: Balaa (yellow-flowered var.), Sumanganaa, Khara- yashtikaa, Balini, Bhadrabalaa, Bhadraudani, Vaatyaalikaa.

Unani: Bariyaara, Khirhati, Khireti, Kunayi.

Siddha/Tamil: Nilatutti.

Action: Juice of the plant— invigorating, spermatopoietic, used in spermatorrhoea. Seeds— nervine tonic. Root—(official part in Indian medicine) used for the treatment of rheumatism; neurological disorders (hemiplegia, facial paralysis, sciatica); polyuria, dysuria, cystitis, strangury and hematuria; leucorrhoea and other uterine disorders; fevers and general debility. Leaves—demulcent, febrifuge; used in dysentery.

Ephedrine and si-ephedrine are the major alkaloids in the aerial parts. The total alkaloid content is reported to be 0.085%, the seeds contain the maximum amount. In addition to alkaloids, the seeds contain a fatty oil (3.23%), steroids, phytosterols, resin, resin acids, mucin and potassium nitrate.

The root contains alkaloids—ephed- rine, si-ephedrine, beta-phenethyl- amine, carboxylated tryptamines and hypaphorine, quinazoline alkaloids— vasicinone, vasicine and vasicinol. Choline and betaine have also been isolated.

A sitoindoside, isolated from the plant, has been reported to exhibit adaptogenic and immunostimulatory activities. Alcoholic extract of the plant possesses antibacterial and antipyretic propeptide. Ethanolic extract of the plant depresses blood pressure in cats and dogs.... sida cordifolia

Damage to part of the brain caused by an interruption to its blood supply. The interruption is most often due to the blockage of a cerebral artery by a blood clot, which may have formed within the artery (see thrombosis), or may have been carried into the artery in the circulation from a clot elsewhere in the body (see embolism). Stroke may also result from localized haemorrhage due to rupture of a blood vessel in or near the brain.

The incidence of stroke rises with age and is higher in men. Certain factors increase the risk. The most important are hypertension and atherosclerosis (and, by association, factors such as smoking that contribute to these disorders). Other risk factors are atrial fibrillation, a damaged heart valve, and a recent myocardial infarction; these can cause clots in the heart which may migrate to the brain.

Symptoms usually develop abruptly and, depending on the site, cause, and extent of brain damage, may include headache, dizziness, visual disturbance, and difficulty in swallowing. Sensation, movement, or function controlled by the damaged area of the brain is impaired. Weakness or paralysis on one side of the body, called hemiplegia, is a common effect of a serious stroke. A stroke that affects the dominant cerebral hemisphere may cause disturbance of language (see aphasia). About a third of major strokes are fatal, a third result in some disability, and a third have no lasting ill effects (see transient ischaemic attack).In some cases, urgent treatment may improve the chances of recovery.

ECG, CT scanning, chest X-rays, blood tests, angiography, and MRI may be used to investigate the cause and extent of brain damage.

If a stroke is proven by scan to be due to thrombosis, thrombolytic drugs may be given.

Anticoagulants may be given if there is an obvious source of an embolism, such as atrial fibrillation or a narrowed carotid artery.

In some cases, antiplatelet agents such as aspirin are given.

In most cases, attention to hydration and pressure areas, and good nursing care, are the most important influences on outcome.

Physiotherapy may restore lost movement or sensation; speech therapy may help language disturbances.... stroke

Inflammation of the vulva and vagina. Vulvovaginitis is often provoked as a result of the infections candidiasis or trichomoniasis. (See also vaginitis; vulvitis.)

walking Movement of the body by lifting the feet alternately and bringing 1 foot into contact with the ground before the other starts to leave it. A person’s gait is determined by body shape, size, and posture. The age at which children first walk varies enormously.

Walking is controlled by nerve signals from the brain’s motor cortex (see cerebrum), basal ganglia, and cerebellum that travel via the spinal cord to the muscles. Abnormal gait may be caused by joint stiffness, muscle weakness (sometimes due to conditions such as poliomyelitis or muscular dystrophy), or skeletal abnormalities (see, for example, talipes; hip, congenital dislocation of; scoliosis; bone tumour; arthritis). Children may develop knock-knee or bowleg; synovitis of the hip and Perthes’ disease are also common. Adolescents may develop a painful limp due to a slipped epiphysis (see femoral epiphysis, slipped) or to fracture or disease of the tibia, fibula or femur.

Abnormal gait may also be the result of neurological disorders such as stroke (commonly resulting in hemiplegia), parkinsonism, peripheral neuritis, multiple sclerosis, various forms of myelitis, and chorea.

Ménière’s disease may cause severe loss of balance and instability.... vulvovaginitis