Contralateral hemiplegia

Introduction The clinical manifestations of the lateral pons syndrome include contralateral limb hemiplegia and pons lateral syndrome (Millard-Gubler syndrome): the lesion is located in the lateral part of the pons, which is a common lesion in the pons. Psychological care is very important: because it will bring a heavy burden of thought to patients, it is necessary to pay attention to and make the patient's ideological work, encourage patients to build confidence in the fight against disease, actively cooperate with family members and medical staff, and insist on exercising limbs. To prevent joint deformities and muscle atrophy.

Cause

Most seen in the pons brain tumor, followed by pons cerebral hemorrhage, pons infarction is less common. Tumor compression or paramedian artery occlusion, affecting the corticospinal tract, medial collaterals, medial longitudinal system, pons cerebellar bundle, and abductor nucleus.

an examination

Related inspection

Random exercise examination of cerebrospinal fluid calcitonin gene-related peptide cerebrospinal fluid leucine-enkephalin

Ipsilateral abductor nerve, facial nerve paralysis, contralateral limb hemiplegia, accompanied by pyramidal tract signs.

Differential diagnosis

(a) cortical and subcortical hemiplegia

In the case of cortical hemiplegia, the upper extremity is obvious and the distal end is. If there is cortical irritation, there is seizure. In the case of parietal lobe lesions, there is a cortical sensory disturbance, which is characterized by shallow sensation, that is, tactile, warm and painful, and normal, while physical sensation, positional sensation, and two-point discrimination are obvious. The sensory disturbance is evident at the distal end. Right side cortical hemiplegia is often accompanied by aphasia, disuse, misrecognition and other symptoms, bilateral subcortical hemiplegia accompanied by disturbance of consciousness, mental symptoms. Cerebral cortical hemiplegia generally has no muscle atrophy, and may have disuse muscle atrophy in the advanced stage; however, hemiplegia caused by parietal tumor may have obvious muscle atrophy. Cortical or subcortical hemiparesis hyperreflexia, but other pyramidal tract signs are not obvious. Cortical and subcortical hemiplegia are the most common causes of middle cerebral artery disease, followed by trauma, tumor, occlusive vascular disease, syphilitic vascular disease or cerebral embolism caused by heart disease.

(2) Internal cystic hemiparesis cones showed internal cystic hemiplegia after injury in the internal capsule. Internal cystic hemiplegia showed upper and lower extremities including the lower facial muscles and the lingual muscles. During hemiplegia, the muscles that are dominated by the bilateral cortex are not involved, namely the masticatory muscles, the throat muscles, and the eyes, trunk, and upper facial muscles. But sometimes the upper facial muscles can be slightly affected, the frontal muscles sometimes have weak visible power, the eyebrows are slightly lower than the contralateral side, and the orbital muscles are weak, but these obstacles are short-lived and quickly return to normal. In the first 2/3 of the hindlimb of the internal capsule, the increase of muscle tension appeared earlier and more obvious. The extensional muscle was easy to appear pathological reflex. The forearm of the internal capsule showed muscle stiffness and the pathological reflex was mainly in the flexor group. The most common cause of internal cystic hemiplegia is bleeding or occlusion of the membranous artery supply area of the middle cerebral artery branch.

(3) Brain stem hemiplegia (also known as cross-biased hemiplegia)

Hemiplegia caused by brain stem lesions is characterized by cross-biased hemiplegia, that is, one side of the cranial nerve palsy and the contralateral upper and lower limbs. The cause is vascular, inflammation and tumors.

1. Midbrain hemiplegia:

(1) Weber's syndrome: it is a typical representative of midbrain cross-biased hemiplegia, which is characterized by lateral oculomotor nerve paralysis and contralateral hemiplegia. Due to oculomotor nerve paralysis, the face appears drooping in the clinic, the pupil is dilated, and the eyeball is in the lower oblique position. Sometimes seeing the eyeball moving sideways to the side, the Foville's syndrome appears, and may be accompanied by a feeling of dullness with the side of the hemiplegia, and cerebellar ataxia. The mechanism is that the lesions are more extensive on the basis of Weber's syndrome, affecting the brainstem lateral center of the eyeball and its path. And the feeling of fiber and cerebellar red nucleus.

(2) Benedikt's symptom group: showed partial hemiplegia on the contralateral side of the lesion, and there was dance and acromosis on the hemiplegia side.

2. pons hemiplegia:

(1) Millard-Gubler's syndrome: ipsilateral facial paralysis and ipsilateral abducens nerve paralysis of the lesion, contralateral hemiplegia of the lesion, showing cross-sectional paralysis. Because the nucleus fibers of the facial nerve intersect at the high level of the pons, they terminate in the facial nucleus in the lower part of the pons, and then the facial nerve fibers are emitted from the sacral nucleus, which goes to the medial side of the nucleus, bypasses the abductor nucleus, and then goes to the ventral medial, at the junction of the pons and the medulla Out of the brain. When the pons of the facial nerve nucleus crosses the cerebral bridge, the ipsilateral facial paralysis of the lesion is reappeared, and the abducens nerve paralysis and the contralateral upper and lower limb pyramidal tract lesions are intersected.

(2) Foville's syndrome: manifested as facial nerve palsy, abductor nerve paralysis and two eyes to the opposite side of the lesion, actually Millard-Gubler's syndrome plus two-eye lateral dyskinesia, it should be called Millard-Gubler-Foville Syndrome. If the lesion invades the ipsilateral trigeminal nerve root plexus or the trigeminal nucleus nucleus, the lesion may be dull in the same side.

3. Medullary hemiplegia:

(1) Upper medullary syndrome: cases of contralateral upper and lower extremities, lesions on the same side of the tongue and tendon and tongue muscle atrophy.

(2) Right side of the medullary syndrome: deep sensation and fine sensory disturbance on the opposite side of the lesion.

(3) medullary dorsolateral syndrome (wallenberg's syndrome): sometimes accompanied by hemiparesis. In addition, there are ipsilateral limb ataxia, nystagmus, ipsilateral soft palate, vocal cord paralysis, facial dysfunction, and Horner's disease.

(4) Babinski-Nageotte's syndrome: contralateral hemiplegia and lateral dissociative sensory disturbance, vascular dyskinesia. Symptoms of ipsilateral facial dysfunction, cerebellar ataxia, Horner's sign, nystagmus, soft palate, pharyngeal and laryngeal paralysis (Avellis syndrome).

(5) lesions at the intersection of the medulla oblongata: the lesions may have contralateral upper and lower extremities before the crossover.

(four) spinal hemiplegia

1. Cone-crossing: When the spinal cord is half-sided, there are upper and lower extremity spasm on the same side of the lesion, but no cranial nerve palsy, deep sensory disturbance on the lesion side, temperature and pain disorder on the contralateral side (Brown-S'equard syndrome) ).

2. Neck enlargement (neck 5 to chest 2) is impaired: hemiplegia may occur. It is characterized by the lower limbs of the lower limbs and the lower limbs of the motor neurons. Various sensory loss, urinary incontinence and neuralgia with upper limbs. There is often a Horner's sign.

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