Paralysis is a common symptom from a traumatic brain injury following an auto or motorcycle accident. I have represented clients over the years who have suffered paralysis resulting from a head injury. Sadly, this condition can have a devastating effect on one’s life.
Hemiplegia is a complete paralysis of one side of the body; hemiparesis is a partial paralysis.
Following closed head injury, paralysis of one side of the body generally is a result of a large subdural hemorrhage or hematoma. The incidence of subdural hematoma is estimated to be 1 to 10 percent of head injuries, both closed and penetrating.
Hemiplegia is caused by pressure against the areas of the brain that govern movement (the motor cortex, or where the corticospinal tracts converge in the brain stem or upper spinal cord). The hemiplegia is of a “spastic” type, with an increase in briskness of the tendon reflexes, as elicited by striking the neurolo gist’s hammer against the patellar (knee) tendon, the tendon at the elbow, or a similar area, and by the presence of an abnormal response when the sole of the foot is vigorously stroked with an object. If the toes fan out and extend when this is done, this is called Babinski s reflex.
Hemiplegia is very often accompanied by a drooping of one side of the face and (rather infrequently) by a large pupil that does not react to light, found on the same side of the head as the hematoma (anisocoria). This phenomenon is caused by the dysfunction of cranial nerve BI (the oculomotor nerve). Paralysis is found on the side of the body opposite the brain lesion, since the motor tracts (corticospinal tracts) cross over on their way to the spinal cord.
Individuals who have sustained a subdural hematoma of a size sufficient to cause hemiplegia or loss of cranial nerve function often experience convulsions.
Generally, when the cause of hemiplegia is treated promptly, by evacuation of the subdural hematoma, the patient makes a good recovery.
However, prolonged spastic paralysis demands intensive rehab ilitation. A variety of serious complications may otherwise result, such as joint immobility, muscle atrophy and contractures, deposits of calcium around the joints (hetero topic ossification), and other disabling effects. Disabilities thus encountered after severe neurologic damage are very incapacitating and invariably involve extensive orthopedic and neurosurgical involvement and continual physical therapy. Surgical procedures, such as nerve transplants and reroutings (neurec tomies), or tendon lengthenings or transfers, may be necessary to return some degree of function to the paralyzed limbs. Hemiplegia that persists following head injury can cause massive disruption to the patient’s daily functions. Driving becomes difficult or impossible.
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