Hemiparesis is the incomplete paralysis of one half of the body. This is a symptom of a serious underlying disease and is triggered by damage to the opposite hemisphere of the brain. If signs of paralysis appear, a doctor must be consulted immediately.
What is hemiparesis?
Hemiparesis can affect people of all ages. The causes are varied and can lead to paralysis of the arms, legs or the muscles in the face, tongue and mouth.
Hemiparesis is always caused by damage to the brain. If the left half of the brain is affected by a disease, the paralysis occurs in the right half of the body. On the other hand, if the right hemisphere of the brain is damaged, the muscles in the left half of the body are paralyzed. The more severe and persistent the disorder and the larger the brain area affected, the more pronounced the symptoms.
Movement disorders, the development of spasticity, reduced sensitivity to touch and pain or, in the worst case, serious mental disorders can be the result of hemiparesis.
The most common cause of hemiparesis is a lack of oxygen in the brain. This can be triggered by a circulatory disorder 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 smoothly from the brain via the spinal cord to the nerves. A stroke does not only occur in old age, but can also affect children. In addition to hemi-paralysis, visual and speech disorders as well as dizziness and sometimes severe headaches can often be observed.
Other causes of hemiparesis can be accidental brain injuries, inflammatory diseases such as meningitis or encephalitis or, more rarely, tumors in the brain. Here the paralysis does not appear suddenly, but develops over hours, days or even weeks.
Symptoms, Ailments & Signs
Hemiparesis manifests itself primarily through 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 excessive.
It is often possible to stand or walk despite paresis (incomplete paralysis), while the affected arm can hardly be used. Despite being able to stand up and move around alone or with help, many hemiplegic people have problems with balance or coordination. Hemiparesis or hemiplegia usually affects the facial muscles, so that the affected person can drip saliva from the corner of the mouth without noticing it.
Even when smiling, the corners of the mouth cannot be raised symmetrically. So it is not surprising that speech disorders can occur. Unfortunately, some patients experience double vision because the muscles that move the affected eyeball are partially paralyzed. Occasionally there are sensory disturbances.
Surfaces, temperatures or objects are perceived imprecisely. For example, it can happen that the person concerned does not feel when hot soup runs over his hand. He can’t explain the blisters that appear later.
Diagnosis & History
Since hemiparesis is only a symptom and not an independent disease, the cause must first be determined in order to be able 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 paralysis (suddenly in the case of strokes and cerebral hemorrhages, gradually in the case of inflammation and tumours). A neurological exam checks the cranial nerves, reflexes, sensitivity to touch, and strength in the arms and legs.
In addition, the carotid artery is examined and the state of tension in the neck is assessed. In order to make pathological changes in the brain visible, the neurologist uses imaging methods such as computed tomography, magnetic resonance imaging ( MRT ) or angiography to clarify the hemiparesis.
Various complications can occur with hemiparesis. Hemiplegia can initially lead to wasting and frailty, often with severe motor dysfunction throughout the body. The internal and external organs can also be affected and damaged in various ways as the disease progresses.
In mild cases, the sense of balance decreases due to the paralysis and there are impairments in the area of mobility. In severe cases, pneumonia and thrombosis develop in the paralyzed limbs and impairment of the excretory organs, along with a number of other complications. In addition, intellectual performance can decrease in the context of hemiparesis.
Depending on the severity of the paralysis, inflammation of the joints is also conceivable. Further complications arise from being bedridden: ulcers (decubitus), urinary tract infections and contractures, joint stiffness, muscle wasting and epilepsy. Hemiparesis can also lead to blood clots and severe pain in the affected body regions due to the paralysis that occurs and the associated circulatory disorders.
This can lead to a stroke or spread of the disease. Whether and to what extent these subsequent 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 go to the doctor?
In the case of hemiparesis, a doctor must be consulted immediately. In the worst case, the paralysis can remain permanent and then no longer be treated. An early diagnosis always has a positive effect on the further course of the disease. The doctor should be consulted for hemiparesis if severe paralysis occurs suddenly and without any particular reason. In most cases, facial paralysis also occurs.
Those affected also suffer from movement and coordination disorders and thus 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 go away on their own. In this way, the permanent occurrence of these disturbances can be avoided.
The examination and treatment can be carried out by a neurologist. In acute emergencies or in the case of severe symptoms, the hospital can also be visited. Further treatment usually depends on the exact cause of the hemiparesis and the patient’s options.
Treatment & Therapy
Hemiparesis therapy is primarily aimed at restoring and maintaining the patient’s independence through various exercises. The treatment depends very much on the underlying disease.
If a stroke is the cause of the symptoms of paralysis, the patient is given anticoagulants immediately. Bleeding usually requires surgery to prevent it from spreading to surrounding tissue. Hemiparesis caused by meningitis or encephalitis is treated by administering antibiotics or antivirals.
A tumor can sometimes be surgically removed. In addition, chemotherapy and/or radiotherapy may be necessary. After the acute treatment, the patient usually receives a rehabilitation program consisting of physiotherapy, ergotherapy and speech therapy in a second step. Orthoses can be used to combat paralysis in the extremities. Treatments with botulinum toxin or operations are also promising.
Another approach is forced use therapy, in which the healthy limbs are fixed in order to encourage the patient to use the paralyzed limbs. Hemiparesis is often accompanied by strong feelings of anxiety. Therefore, psychotherapy is recommended.
Outlook & Forecast
A distinction must be made between people who had hemiparesis at birth and people who developed the disease as a result of a stroke. For the first group there is no chance of recovery. Although therapies show how to cope with everyday life, help is 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. Movement disorders can be minimized with individual therapy.
Nerve areas can then remodel. However, the effort is great. Recovery can take months and years. While other people can improve their sensitivity, they remain dependent on help for life.
Patients can take steps themselves to improve their prognosis. It has been scientifically proven that alcohol and cigarettes counteract healing. Instead, patients should pay attention to a healthy and balanced diet. Existing excess weight must be reduced. Movement should be within the limits of what is possible.
Since hemiparesis is usually triggered by a stroke, risk factors such as high blood pressure or calcification of the vessels must be combated. A healthy lifestyle with a balanced diet and sufficient exercise avoids obesity and makes a decisive contribution to maintaining health. If the blood vessels are already constricted by deposits or if there are cerebral circulatory disorders, the administration of medication is a must.
Depending on the cause of the hemiparesis, different aftercare measures are necessary. If the hemiparesis was based on a tumour, chemotherapy or radiotherapy is often carried out as part of the aftercare. If hemiplegia is caused by a blood clot (thrombosis), doctors prescribe medication to thin the blood. These have a preventive effect and prevent the formation of further thrombosis.
In order to restore the greatest possible mobility of the paralyzed muscles, physiotherapy is an integral part of effective aftercare. Special movement exercises are intended to give the patient back a high degree of independence. The earlier and more intensively the physiotherapy begins, the more effectively the paralyzed body regions can be restored. However, full recovery is rarely possible.
If the hemiparesis has also affected the facial muscles, speech therapy is also part of the aftercare. The aim is to increase speech intelligibility. If spasms persist despite physiotherapy or speech therapy, Botox is sometimes used to relax the muscles. This relieves spasmodic flare-ups.
After hemiparesis, the patient often has to prove his or her fitness to drive in the course of an assessment, since the hemiparesis may have led to impairments. Since hemiparesis is associated not only with the physical limitations but also with a high level of psychological stress, there is often an accompanying psychotherapy.
You can do that yourself
Direct self-help or options for self-treatment are usually not possible with hemiparesis. The disease can only be partially prevented by leading a healthy lifestyle. This includes a healthy diet and sufficient physical activity. Above all, obesity should be avoided so as not to trigger hemiparesis.
Since those affected by this disease suffer from severe paralysis and thus limitations in their lives, 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 also alleviate or prevent psychological problems.
In many cases it is also worth contacting other people affected or a psychologist to talk about the possible course of the disease. It can also help resolve any feelings of anxiety. In the case of children in particular, 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 ambulance must be called immediately. The person concerned should be placed in a stable lateral position and calmed down until they enter.