Anatomical diagnosis in hemiplegia

Diagnosis of anatomical site of the lesion in hemiplegia depends upon associated
-clinical features of involvement of other ascending /descending tracts and nuclei
Features of hemiplegic lesions at various levels:
1. cortical lesions:
o Loss of consciousness
o Monoplegia or hemiplegia with predominant
 -involvement of one limb
o Cortical sensory loss
o Fits can occur
o Flaccidity
o Aphasia when dominant hemisphere involved
o Visual field defects
2. Corona radiata: same features as above but denser hemiplegia
3. Internal capsule:
1. dense motor hemiplegia with upper motor neuron type of
facial palsy
2. But emotional facial movements are retained despite facial
palsy
3. no fits, no visual field defects and no sensory symptoms
usually.
4. Brain stem lesions :
1. Typically cause ipsilateral cranial nerve palsy and contra lateral
hemiplegia. This condition being known as crossed hemiplegia
Mid brain: example of crossed hemiplegia –e.g. Weber’s syndrome
Pons: crossed hemiplegia –e.g. Millard –Gubler’s syndrome
Medulla: lower cranial nerve involvement