Hemiparesis and Hemiplegia

Overview
Hemiplegia refers to a complete lack of motor function. Hemiparesis refers to decreased motor function. Both are usually a result of a problem with the brain

Differential Diagnosis
In alphabetical order.


 * Amyotrophic Lateral Sclerosis
 * Brain tumors
 * Brown-Sequard Syndrome
 * Cerebral abscess
 * Cerebral Palsy
 * Chronic subdural hematoma
 * Complicated Migraine
 * Congenital structural anomalies
 * Demyelinating syndrome
 * Guillain-Barre Syndrome
 * Inflammatory conditions
 * Intracerebral hemorrhage
 * Meningitis
 * Multiple Sclerosis
 * Periodic paralysis
 * Psychogenic or hysterical weakness
 * Reversible ischemic neurologic deficits (RINDs) last 24-72 hours
 * Syphilis
 * Thromoboembolic infarction
 * Todd's Paralysis
 * Transient ischemic attacks
 * Transverse Myelitis
 * Trauma

History and Symptoms

 * Onset
 * Past history
 * Associated symptoms/findings
 * Pattern of weakness

Laboratory Findings

 * Complete blood count (CBC)
 * Prothrombin time / partial thromboplastin time (PT / PTT)
 * Glucose
 * Calcium
 * Blood urea nitrogen (BUN) / creatinine

Electrolyte and Biomarker Studies

 * Electrolytes

MRI and CT

 * Both MRI and CT scans are the diagnostic tool of choice

Other Diagnostic Studies

 * Cerebrospinal fluid (CSF) anaylsis is useful for patients suspected of having multiple sclerosis

Treatment

 * Identifying and treating the underlying cause are the best ways to manage hemiplegia and hemiparesis
 * Physical therapy
 * Occupational therapy
 * Orthotics
 * Management of blood pressure and blood sugar (cerebral infarction)

Acute Pharmacotherapies

 * Thrombolytics (cerebral infarction)
 * Steroids (multiple sclerosis)

Surgery and Device Based Therapy

 * Assistive devices for general measures
 * Surgical management for mass lesions affecting the brain

Acknowledgements
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