Overview

Myasthenia gravis is a disease-causing fluctuating weakness of muscles like that of the limbs, swallowing and eye movement muscles. Myasthenia gravis (autoimmune type) happens when your body’s immune system mistakenly attacks itself. Myasthenia gravis affects how your nerves communicate with your muscles. It leads to muscle weakness that worsens throughout the day and with activity. Drooping eyelids and/or double vision are often the first sign Researchers aren’t sure why this happens. Studies suggest that certain immune system cells in your thymus gland have trouble identifying what’s a threat to your body (like bacteria or viruses) versus healthy components. A genetic changes causes congenital myasthenia. Antibodies passed from a birthing parent to a fetus during pregnancy cause neonatal myasthenia. Medications and surgery can help relieve the symptoms of this lifelong illness. Treatment includes medications  that can reduce your symptoms. Monoclonal antibodies: Doctor will give intravenous (IV) or subcutaneous (SQ) infusions of biologically engineered proteins. These proteins suppress an overactive immune system, Plasma exchange (plasmapheresis): An IV connected to a machine removes harmful antibodies from your blood plasma and replaces them with donor plasma or a plasma solution.  Last option is  thymectomy surgery is done to remove the thymus gland.

Causes

Myasthenia gravis (autoimmune type) happens when your body’s immune system mistakenly attacks itself. Researchers aren’t sure why this happens. Studies suggest that certain immune system cells in your thymus gland have trouble identifying what’s a threat to your body (like bacteria or viruses) versus healthy components.

A genetic change causes congenital myasthenia. Antibodies passed from a birth mother to a fetus during pregnancy cause neonatal myasthenia.

Symptoms

Symptoms of myasthenia gravis may include:

• Muscle weakness in your arms, hands, fingers, legs and neck.
• Fatigue.
• Droopy eyelids (ptosis).
• Blurry or double vision.
• Limited facial expressions.
• Difficulty speaking, swallowing or chewing.
• Trouble walking.

Initial symptoms of myasthenia gravis happen suddenly. Your muscles usually get weaker when you’re active. Muscle strength returns when you rest. The intensity of muscle weakness often changes from day to day. Most people feel strongest at the start of the day and weakest at the end of the day.

In rare instances, myasthenia gravis affects muscles in your respiratory system. You may have shortness of breath or more serious breathing problems. Contact 911 or your local emergency services number if you have trouble breathing. In general, this doesn’t occur suddenly.

Types of myasthenia gravis

The types of myasthenia gravis include:

• Autoimmune myasthenia: It’s an autoimmune condition where the cause isn’t well understood but the likely cause is the production of certain types of antibodies (immune system proteins). This is the most common type.
• Neonatal myasthenia: A fetus gets certain antibodies from their birth mother who has myasthenia gravis. An infant may have a weak cry or sucking reflex at birth. These temporary symptoms usually go away after three months.
• Congenital myasthenia: It isn’t an autoimmune condition, and a genetic change causes this type.

There are two subtypes of autoimmune myasthenia:

• Ocular: The muscles that move your eyes and eyelids weaken. Your eyelids may droop, or you may not be able to keep your eyes open. Some people have double vision. Eye weakness is often the first sign of myasthenia. Ocular myasthenia gravis may evolve into the generalized form for nearly half of all people diagnosed with this type.
• Generalized: Muscle weakness affects your eye muscles and others in your face, neck, arms, legs and throat. You may find it difficult to speak or swallow, lift your arms over your head, stand up from a seated position, walk long distances and climb stairs.

Risk factors for myasthenia gravis include:

Myasthenia gravis is most common among females around age 40 and males after age 60. The condition can affect anyone at any age.

You may be more at risk of developing myasthenia gravis if you:

• Have a history of other autoimmune conditions, such as rheumatoid arthritis and lupus.
• Have thyroid disease.

If you have myasthenia gravis, your symptoms could trigger (start) if you:

• Take medications for malaria and heart arrhythmias.
• Underwent surgery.
• Had an infection.

Diagnosis and Tests

Testing confirms a diagnosis. It may include:

• Blood antibody tests: About 85% of people with myasthenia gravis have unusually high levels of acetylcholine receptor antibodies in their blood. Approximately 6% of people diagnosed have muscle-specific kinase (MuSK) antibodies.
• Imaging scans: An MRI or CT scan can check for thymus gland problems like tumors.
• Electromyography (EMG): An EMG measures the electrical activity of muscles and nerves. This test detects communication problems between nerves and muscles.

Myasthenia gravis stages

There are five main classifications of myasthenia gravis that your healthcare provider may use during a diagnosis:

• Class I: Muscle weakness only affects your eyes (ocular muscle).
• Class II: Muscle weakness is mild.
• Class III: Muscle weakness is moderate.
• Class IV: Muscle weakness is severe.
• Class V: Severe muscle weakness affects how you breathe. You may need intubation or mechanical ventilation.

Management and Treatment

There’s no cure for myasthenia gravis. But effective treatment is available to help manage your symptoms. Treatments may include:

• Medications: Certain medications can reduce your symptoms.
• Monoclonal antibodies: You’ll receive intravenous (IV) or subcutaneous (SQ) infusions of biologically engineered proteins. These proteins suppress an overactive immune system.
• Plasma exchange (plasmapheresis): An IV connected to a machine removes harmful antibodies from your blood plasma and replaces them with donor plasma or a plasma solution.
• IV or SQ immunoglobulin (IVIG or SCIG): You’ll receive IV infusions of donor antibodies over two to five days. IVIG or SCIG can treat myasthenia crisis, as well as generalized myasthenia gravis.
• Surgery: A thymectomy is surgery to remove the thymus gland.

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Overview

Porencephaly is a structural abnormality of the brain. It may manifest before or after birth. It is a very rare disorder that affects your central nervous system, children with this condition develop fluid-filled cavities, or cysts, on their brain. These brain cysts can delay and impair your child’s growth and development. These cysts can interfere with normal brain growth and development. Children with porencephaly may experience speech difficulties. They may also have other neurological deficits (abnormal functioning in areas of their body).However, on rare occasions, it can be related to an inherited genetic condition. There is no clear cure for porencephaly. However, there are many ways to manage its effects. Treatments focus on improving neurological impairments. If hydrocephalus is present, excess fluid around your child’s brain can be drained.

SYMPTOMS

Possible symptoms include: 

• Motor delay (differences in muscle tone, movement, posture, or developmental milestones) 
• Speech and language delay 
• Learning challenges 
• Cognitive or intellectual differences 
• Slow overall growth 
• Developmental delays in multiple areas (global delays) 
• Seizures 
• Spastic hemiplegia (stiffness and weakness in limbs)  
• Hypotonia (low muscle tone) 
• Macrocephaly (large head) 
• Microcephaly (small head) 
• Hydrocephalus (increased pressure in the brain) 

Causes

With a lack of oxygen or bleeding in your child’s brain, fluid-filled cysts can replace normal brain tissue. This is more likely to happen if the following risk factors are present:

• Alcohol or drug use during pregnancy.
• Gestational diabetes.
• Infection during pregnancy.
• Infection shortly after birth.
• Trauma during birth.
• Other causes of stroke or lack of oxygen to their brain (like blood disorders and metabolic diseases). Sometimes, healthcare providers can find clues about the underlying cause based on the location, size and distribution of the cysts.

• Some types of porencephaly are genetic and can be inherited. This means that a person only needs one abnormal gene copy to show symptoms. The abnormal gene can be inherited from a mother or father. A person with a COL4A1 or COL4A2 gene mutation has a 50 percent chance of passing on condition. Two people with the same mutation may have very different symptom severity.  

Diagnosis

To confirm a diagnosis of porencephaly, your healthcare provider needs to see detailed images of your child’s brain. You or your child may have imaging tests like:

• Prenatal ultrasound or ultrasound.
• CT scan.
• MRI.

Management and Treatment

Outlook

Overview

Ataxia describes poor muscle control that causes clumsy movements. It can affect walking and balance, hand coordination, speech and swallowing, and eye movements.

Ataxia usually results from damage to the part of the brain called the cerebellum or its connections. The cerebellum controls muscle coordination. Many conditions can cause ataxia, including genetic conditions, stroke, tumors, multiple sclerosis, degenerative diseases and alcohol misuse. Certain medicines also can cause ataxia. If ataxia is caused by a condition such as vitamin deficiency or celiac disease, treating the condition may help improve symptoms. Some studies have found that aerobic and strength exercises may be beneficial for some people with ataxia

Causes

Ataxia is caused by damage to the part of the brain called the cerebellum or its connections. The cerebellum is located at the base of the brain and connects to the brainstem. The cerebellum helps control balance, eye movements, swallowing and speech.

There are three major groups of ataxia causes: acquired, degenerative and hereditary.

Acquired causes

• Ataxia is a potential side effect of certain medicines. It can be caused by sedatives such as phenobarbital and benzodiazepines. It also may be caused by anti-seizure medicines, especially phenytoin. Some types of chemotherapy also can cause ataxia.
• Heavy metal poisoning, such as from lead or mercury, and solvent poisoning, such as from paint thinner, also can cause ataxia.
• Too little or too much of certain vitamins.Ataxia may be caused by not getting enough vitamin E, vitamin B-12 or vitamin B-1, also known as thiamine. Too little or too much vitamin B-6 also may cause ataxia. Not getting enough of a certain vitamin is known as a vitamin deficiency. When a vitamin deficiency is the cause of ataxia, it often can be reversed.
• Thyroid conditions.Hypothyroidism and hypoparathyroidism can cause ataxia.
• Sudden onset of ataxia occurs with a stroke. This may be either due to a blood vessel blockage or bleeding on the brain.
• Multiple sclerosis.This condition may cause ataxia.
• Autoimmune diseases.Several diseases in which the immune system attacks healthy cells, known as autoimmune diseases, can cause ataxia. They can include a disease that causes inflammatory cells to collect in parts of the body, known as sarcoidosis. Or they may include an illness caused by an immune reaction to eating gluten, known as celiac disease. Ataxia also can be caused by certain types of a condition that results in swelling in the brain and spinal cord, called encephalomyelitis.
• Rarely, ataxia may be a symptom of chickenpox in childhood and other viral infections such as HIV and Lyme disease. It might appear in the healing stages of the infection and last for days or weeks. The symptom usually gets better over time.
• COVID-19.Ataxia can result from a serious infection with the virus that causes COVID-19.
• Paraneoplastic syndromes.These are rare degenerative conditions triggered by an immune system response to a cancerous tumor, known as a neoplasm. Paraneoplastic syndromes most often occur from lung, ovarian or breast cancer or lymphoma. Ataxia can appear months or years before the cancer is diagnosed.
• Changes in the brain.An infected area in the brain, known as an abscess, may cause ataxia. And a growth on the brain, such as a cancerous or noncancerous tumor, can damage the cerebellum.
• Head trauma.Brain damage may cause ataxia.
• Cerebral palsy.This is a general term for a group of conditions caused by damage to a child’s brain. The damage may happen before, during or shortly after birth. It affects the child’s ability to coordinate body movements.

Degenerative causes

• Multiple system atrophy.This rare condition affects movements and functions such as blood pressure. It can cause ataxia and other symptoms, including lack of bladder control, fainting after standing up and a sleep behavior condition in which a person acts out dreams.

Hereditary causes

Some types of ataxia and some conditions that cause ataxia are passed down in families. These conditions also are called hereditary. If you have one of these conditions, you may have been born with a genetic change that causes the body to make irregular proteins.

 

 

Symptoms

Ataxia symptoms can develop over time or start suddenly. Ataxia can be a symptom of several nervous system conditions. Symptoms may include:

• Poor coordination.
• Walking unsteadily or with the feet set wide apart.
• Poor balance.
• Trouble with fine motor tasks such as eating, writing or buttoning a shirt.
• Changes in speech.
• Back-and-forth eye movements that can’t be controlled.
• Trouble swallowing.

Treatments

Ataxia treatment depends on the cause. If ataxia is caused by a condition such as vitamin deficiency or celiac disease, treating the condition may help improve symptoms. If ataxia results from chickenpox or other viral infections, it is likely to resolve on its own.

People with Friedreich ataxia can be treated with an oral medicine called omaveloxolone (Skyclarys). The U.S. Food and Drug Association approved the medicine for adults and teenagers 16 and older. In clinical trials, taking the medicine improved symptoms. People who take this medicine need regular blood tests because omaveloxolone can affect liver enzyme and cholesterol levels. Potential side effects of omaveloxolone include headache, nausea, stomach pain, fatigue, diarrhea, and muscle and joint pain.

Symptoms such as stiffness, tremor and dizziness might improve with other medicines. Your healthcare professional also might recommend adaptive devices or therapies.

Adaptive devices

Ataxia caused by conditions such as multiple sclerosis or cerebral palsy might not be treatable. But adaptive devices may help. They include:

• Hiking sticks or walkers for walking.
• Modified utensils for eating.
• Communication aids for speaking.

Therapies

You might benefit from certain therapies, including:

• Physical therapy to help with coordination and enhance mobility.
• Occupational therapy to help with daily living tasks, such as feeding yourself.
• Speech therapy to improve speech and aid swallowing.

Some studies have found that aerobic and strength exercises may be beneficial for some people with ataxia.

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Overview

An encephalocele is a rare congenital type of neural tube defect (NTD) where part of the skull has not formed properly during fetal development, so a portion of brain tissue and associated structures are outside the skull. The protruding sac may be covered with skin or it may be covered with a thin membrane can occur anywhere along the skull, but most common in the back of the head, top of the head, or between the forehead and nose with multiple complications like Buildup of fluid in the brain, loss of strength in the arms and legs, developmental delay, intellectual disability, seizures. Encephaloceles can vary in size, from a small protrusion to a sphere that’s the same volume as the skull. If the encephalocele is large, the baby’s head may be too big to fit through the birth canal, which may require a cesarean section. Treatment usually happens shortly after birth or within the first few months to a year, depending on the size, location and effects the condition has on your baby. Children usually need more than one surgery to treat this condition. Surgery can also treat facial growth irregularities and hydrocephalus.

Types of encephalocele

The types of encephalocele identify the location of the opening in the skull:

• Occipital: The lower back of your baby’s head.
• Parietal: Top, nearest the back of your baby’s head.
• Frontoethmoidal (also called sincipital): Near your baby’s forehead.
• Sphenoidal: Front-middle or behind your baby’s eyes and in front of their ears.

In addition, you may hear your child’s healthcare provider mention two broader categories of encephalocele:

• Anterior: Front of your child’s skull.
• Posterior: Back of their skull.

Causes

A newborn with encephalocele will have a gap in their skull that isn’t closed. This causes a bulge or sac of brain tissue covered in skin coming out of the skull opening. This can look similar to a balloon coming out of your child’s head. Depending on where the skull opening is, the skin on the sac may have hair on it.

Most encephaloceles are congenital (meaning you’re born with it), but some can be acquired as a result of trauma, tumor or other rare conditions such as idiopathic intracranial hypertension.

The skull opening can happen anywhere on their head. It’s most common on the forehead or the lower back of their head near the base of your baby’s skull.

The exact reason why the neural tube doesn’t close completely is unknown. Research suggests it could be the result of:

• A genetic change that happens during conception.
• An infection (toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus).
• A neurological (brain or nerve) condition (like type 3 Chiari malformation).

An underlying medical condition may lead to encephalocele. These conditions include:

• Walker-Warburg syndrome.
• Knobloch syndrome.
• Roberts syndrome.
• Amniotic band syndrome.

Signs and symptoms

• Headache.
• Visual problems.
• Muscle weakness in arms and legs.
• A smaller-than-expected head size at birth.
• Uncoordinated movements (ataxia).
• Facial malformations.
• Nasal obstruction.
• Spinal fluid leaking from nose or ear.

Diagnosis and Tests

If the encephalocele is large, it may be seen on routine prenatal ultrasound, which may allow planning of a caesarean section if it could be risky to have the baby vaginally. Otherwise, in most cases an encephalocele will be visible at birth so is easily diagnosed. Very small encephaloceles, especially those in the nose/forehead area may not be so visible.

Once an encephalocele is suspected, the diagnosis will usually be confirmed with imaging scans, such as magnetic resonance imaging (MRI) scans. This will allow doctors to see exactly how much of the skull is affected and whether the sac contains meninges or brain tissue or both.

As encephaloceles can be associated with other problems, so the doctors will examine the child closely to check if this is the case.

Treatment and Prevention

Treatment for encephalocele is surgery to repair the skull and remove brain tissue that grew outside of the skull. Often, the portion of the brain that’s outside of the skull isn’t functional and can be removed. When the opening is small, sometimes, the brain can be gently moved back into the skull before a surgeon repairs the skull.

Treatment usually happens shortly after birth or within the first few months to a year, depending on the size, location and effects the condition has on your baby.

Children usually need more than one surgery to treat this condition. Surgery can also treat facial growth irregularities and hydrocephalus.

As your child grows, they may need additional support to treat associated conditions like:

• Special education programs in school.
• Medications for seizures.
• Glasses for vision problems.

There’s no known way to prevent encephalocele. You can reduce your risk of having a child with a neural tube defect by getting plenty of folic acid.

Talk to your healthcare provider before you plan on becoming pregnant. They may recommend you take 400 mcg of folic acid daily, even if you don’t plan to get pregnant right away. Neural tube defects (NTDs) happen in the first month of pregnancy. This is often before you even know you’re pregnant, which is why it’s essential to start taking folic acid early.

In addition, let your healthcare provider know if you have a family history of NTDs or if you had a child with an NTD. Your provider can help you prevent future NTDs.

To conclude

Babies can survive encephalocele. Treatment with surgery to repair the skull can help them survive. Babies with large skull openings may have more symptoms and complications than babies with smaller openings. This increases their risk of life-threatening outcomes or a shorter life expectancy.

Studies found that newborns with skull openings near the front of their heads have a better outcome than babies with openings in the back of their heads.

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Overview

Any space-occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy. The most common type is cervical spondylotic myelopathy, which happens after natural changes to your body as you age. It can cause neck pain, muscle weakness and numbness, among other symptoms. Surgery treats cervical myelopathy.

Once the disorder is diagnosed, complete remission to normality never occurs and spontaneous temporary remission is uncommon. In 75% of the patients, episodic worsening with neurological deterioration occurs, 20% have slow steady progression, and 5% experience rapid onset and progression.

Symptoms and Causes

The symptoms of cervical myelopathy and cervical spondylotic myelopathy include:

• Neck pain or stiffness.
• Numbness or tingling in your hands and arms.
• Muscle weakness in your hands and arms.
• Loss of balance and difficulty walking.
• Difficulty with fine motor skills (like buttoning a shirt or holding silverware).

Common causes of compression include:

• Bone spurs.
• Herniated disk.
• Narrow cervical canal (birth defect).
• Rheumatoid arthritis.
• Spondylolisthesis.
• Spinal degeneration.
• Spinal stenosis.
• Traumatic injury.
• Tumor.

Cervical spondylotic myelopathy happens due to age-related changes that affect the structure and function of parts of your spine in your neck (spinal degeneration). These changes narrow the spinal canal (the opening where your spinal cord sits), which puts pressure on your spinal cord. Degenerative changes are a natural part of getting older.

Risk factors for cervical myelopathy..

Cervical myelopathy can affect anyone at any age. Studies show it’s more common among people of Asian descent older than 30 years.

Cervical spondylotic myelopathy can affect anyone as well, but it’s more common among men and people assigned male at birth and adults after age 40. The average age of a diagnosis is 64.

If left untreated, cervical myelopathy symptoms may get worse. This might cause:

• Severe pain.
• Bowel and bladder dysfunction.
• Nerve damage.
• Difficulty walking (instability, high risk of falls).
• Limited use of your fingers, hands and arms.
• Paralysis.

Overview

Paralysis, paresis, and plegia are all terms related to loss of motor function,  A nervous system problem causes paralysis Even though both paralysis and paresis are related to muscle weakness, there is a significant difference in their severity and how they affect the human body. Plegia, or paralysis, is a complete paralysis of skeletal muscles. whereas paresis is partial or restricted weakness of the muscles. Understanding the differences between paralysis and paresis is essential for proper diagnosis and treatment. Homoeopathic remedies can help improve muscle strength, reduce pain, and support the body’s natural healing processes in addition to this lifestyle changes and physical therapy can also help treat paresis and paralysis.

Overview

One of the functions of your nervous system is to move your body’s muscles. This includes movements that you control (voluntary) and those that you don’t (involuntary).Paralysis occurs when you’re unable to make voluntary muscle movements. When a part of the nervous system becomes damaged, it can disrupt the signaling activity to a muscle or muscle group. This can lead to muscle weakness (paresis) or paralysis in the affected area. Monoplegia is often caused by cerebral palsy. It can also be caused by an injury or trauma to the brain, spinal cord, or affected limb. therefore monoplegia is a form of paralysis that affects just one limb. most commonly an arm, even though it can also affect one of your legs. The main symptom of monoplegia is the inability to move one of your arms or legs. There’s currently no cure for paralysis, including monoplegia. Instead, treatment aims to address the symptoms while improving quality of life.

Causes  Of Monoplegia

Monoplegia is often caused by cerebral palsy. It can also be caused by an injury or trauma to the brain, spinal cord, or affected limb.

Other possible, though less common causes, include:

• stroke
• tumors affecting the brain or spinal cord
• peripheral nerve compression, due to conditions like a herniated disc, bone spurs, or a tumor
• nerve inflammation (neuritis)
• peripheral neuropathy
• a motor neuron disease that affects a single limb, such as monomelic amyotrophy
• autoimmune neurological diseases such as multiple sclerosis or Guillain-Barre syndrome (GBS)
• Epilepsy
• Aneurysm
• Lumbar radiculopathy

Symptoms of monoplegia paralysis

• Decreased sensation
• Muscle stiffness or spasms
• Feelings of numbness or tingling
• Loss of muscle tone or muscle floppiness
• Curling of the fingers or toes on the affected limb

Diagnosis of monoplegia

Diagnosis of monoplegia involves the following steps:

• Medical History: A detailed medical history of the patient will be taken to gather information about any underlying diseases that may have caused the monoplegia. For example, if there is rapid onset of symptoms, it is suggestive of stroke. Therefore, the medical history will help the doctors to decide on investigations that need to be performed to clinch the diagnosis.
• Physical Examination: A thorough physical exam will be done to assess the condition and help to identify the underlying cause. For example, if there is back pain or radicular pain (pain radiating down the spinal cord), it may be due to compression of the nerves, possibly by a tumor. The physical exam will also detect any motor weakness or loss of sensation in the affected limb.
• Computed Tomography (CT) Scan: This imaging technique involves a combination of X-rays and computer technology to produce cross-sectional images (‘slices’) of internal body structures. CT scanning can be used for the diagnosis of stroke and its complications such as hemorrhage or bleeding.
• Magnetic Resonance Imaging (MRI): This imaging technique uses a magnetic field combined with radio waves and a computer to produce very detailed and accurate images of the internal structures. MRI is the imaging modality of choice for diagnosis of acute ischemic stroke. MRI can also detect brachial neuritis caused by varicella-zoster virus (VZV).
• Electromyography (EMG): This technique assesses muscle function. Electrical sensors are attached to the affected limb and the electrical activities of the nerves that innervate the muscles are measured. For example, conditions such as brachial plexopathy can be diagnosed by performing nerve conduction studies using EMG.

Monoplegia vs Hemiplegia

Monoplegia and hemiplegia are both types of paralysis. but how do they vary from each other?

Monoplegia is paralysis that affects a single limb of the upper or lower part of the body. so, for instance, if you had monoplegia and could not move your right arm, you would still be able to move your right leg. hemiplegia is paralysis that affects one side of the body. either/or the right side or the left side of the body can be affected.

If you had hemiplegia on your right side you would not be able to move your right arm and right leg. the muscles on the right side of your face might further be affected. spell the two conditions are dissimilar hemiplegia and monoplegia share many of the same potential causes. this can include things like injury, stroke, and cerebral palsy.

Treatment for Monoplegia

There’s currently no cure for paralysis, including monoplegia. Instead, treatment aims to address the symptoms while improving quality of life.

Treating the underlying cause of monoplegia is important.

Some of the potential treatment options for monoplegia include:

• Physical therapy: PT can be used to help maintain or build strength, flexibility, and mobility in the affected limb. Stretches, exercises, or massage may be used to help stimulate muscles and nerves.
• Occupational therapy: Occupational therapy teaches different techniques to make it easier to perform everyday tasks like getting dressed, bathing, or cooking.
• Assistive devices: These devices can make day-to-day activities easier. A few examples include walkers, wheelchairs, specialized grips and handles, and voice-activated devices.
• Medications: Medications may help reduce some of the symptoms associated with monoplegia. Examples include pain medications to alleviate discomfort and muscle relaxants for muscle stiffness or spasms.
• Surgery: If monoplegia is due to a tumor or nerve compression, surgery may be needed.

Conclusion

Monoplegia can affect the upper or lower body, either one arm or one leg. Symptoms can appear suddenly or progress gradually over time. Monoplegia is often caused by cerebral palsy. But it can also be the result of an injury or trauma to the brain, spinal cord, or the affected limb. Although monoplegia can sometimes improve over time, it may be permanent in some individuals. Treatment options typically focus on alleviating symptoms and improving quality of life.

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Overview

Paraplegia is a type of paralysis characterized by the loss of motor, sensory, and limb function in the lower half of the body. It is a result of severe damage to the spinal cord and the nervous system or a result of an accident or a chronic condition. Paraplegia mainly affects the trunk, legs, and the pelvic region. You might have trouble moving your legs, feet, and stomach muscles. A doctor may prescribe physical or occupational therapy to help with pain and muscle issues. Physical therapy can also help a person preserve their strength and range of motion. Devices to support mobility, such as a wheelchair or a mobility scooter, are usually necessary. A doctor might also suggest some medications. For example, taking muscle-relaxing medications can help with pain or spasms. Taking blood-thinning medications will reduce the risk of blood clots. In some cases, surgery might be necessary. Surgery can help with swelling and removing lesions. There are currently no treatments to prevent or reverse paraplegia. However, it is possible to treat some of the symptoms and complications that occur. It is also possible for some people to regain partial or complete control over affected areas with time.

Types of Paraplegia

The type of Paraplegia depends on the symptoms and severity of the condition. Some common types of Paraplegia are mentioned below.

Complete Paraplegia

Complete Paraplegia is the total loss of motor and sensory function in the lower body due to spinal cord injury or disease. It can often lead to loss of bladder or bowel control.

Partial Paraplegia

Partial paralysis involves limited muscle function and sensation loss due to nerve damage or injury. Unlike complete paralysis, some movement and feeling remain, though they may be impaired.

Traumatic Paraplegia

Traumatic Paraplegia occurs when a severe injury, like a spinal cord trauma resulting from accidents, falls, or sports-related incidents, leads to paralysis of the lower body. This condition disrupts nerve signals between the brain and lower limbs, causing loss of sensation and movement control.

Non-Traumatic Paraplegia

Non-traumatic Paraplegia refers to lower body paralysis not caused by physical injuries. It can result from conditions like spinal tumors, infections, autoimmune diseases, or congenital abnormalities. Nerve signal disruption causes loss of sensation and motor function. Treatment involves addressing the underlying cause and rehabilitation and assistive measures to improve daily living and mobility.

Spastic Paraplegia

Spastic Paraplegia is a neurological disorder characterized by muscle stiffness and weakness, predominantly affecting the legs. It often stems from genetic mutations impacting nerve cells that control movement. This condition leads to difficulty in walking and coordination. Management includes therapies to alleviate symptoms and enhance functional abilities.

Congenital Paraplegia

Congenital Paraplegia is a rare condition present at birth, involving partial or complete paralysis of the lower body. It can result from genetic mutations, prenatal factors, or developmental issues affecting the spinal cord. Medical intervention and therapies support affected individuals in managing mobility challenges and maximizing their independence and quality of life.

Causes

People with paraplegia usually have an injury to the brain or spinal cord that prevents signaling to the lower body. The loss of signaling causes paralysis of the lower body.

According to the National Spinal Cord Injury Statistical Center, since 38.3% of spinal injuries have been the result of a vehicle accident, and 31.6% have been from falls. Some other common causes include violent crimes and sporting accidents.

Some chronic conditions can also lead to paraplegia. Conditions that might cause paraplegia include:

• tumors or lesions of the spine or brain
• neurological conditions, such as strokeTrusted Source or cerebral palsyTrusted Source
• autoimmune conditions, such as multiple sclerosis

There are many symptoms that can occur in paraplegia. Sometimes, these symptoms will change over time, or even from day to day.

Symptoms might include:

• a loss of sensation in the lower body
• impaired mobility
• weight gain
• depression
• phantom bouts of pain or sensation in the lower body
• chronic pain
• sexual dysfunction
• difficulty with bladder and bowel function
• secondary infections, such as bedsores and skin problems
• autonomic dysreflexia

To diagnose paraplegia, a doctor will assess the person’s symptoms and medical history. They may also ask about recent accidents and whether or not the person has any family history of certain conditions.

It is important that they establish the cause of paraplegia to determine the most suitable treatment options.

Diagnosing paraplegia will usually involve medical imaging. These tests help doctors assess the damage and identify the cause of paralysis. For example, they might use an MRI scan, a CT scan, or an X-ray.

To test nerve functioning, the doctor may use electromyography. This test measures the body’s responses to the stimulation of the muscle.

Treatment Options for Paraplegia

There are several options for treating and managing Paraplegia. Depending on the condition and the severity, rehabilitation, assistive devices, medications, surgery, adaptive strategies, psychotherapy, and experimental therapies are options.

Physical Therapy

Physical therapy is pivotal in treating Paraplegia by enhancing muscle strength, flexibility, coordination, and overall mobility in the affected areas. Therapists employ exercises and techniques tailored to the individual’s needs and abilities. This helps improve range of motion, prevent muscle atrophy, manage spasticity, and develop adaptive strategies for daily activities. To maximize functional independence and enhance the quality of life for people with paraplegia, regular physical therapy sessions are a necessity.

Occupational Therapy

Occupational therapy is essential in paraplegia treatment, concentrating on developing practical skills for independent living. Therapists teach techniques for tasks such as self-care, home management, and work-related activities. They recommend adaptive equipment and strategies to enhance the individual’s ability to navigate daily life, fostering self-sufficiency and improving overall well-being despite the challenges posed by Paraplegia.

Medications

Medications are used to manage various aspects of Paraplegia. Muscle relaxants can help alleviate spasticity and muscle stiffness. Pain relievers address discomfort. Antidepressants and anti-anxiety drugs assist with emotional well-being. Blood-thinning medications reduce the risk of deep vein thrombosis—bladder and bowel control medications aid in managing urinary and fecal functions. To enhance mobility and quality of life for individuals with paraplegia, medication plans are tailored to their individual needs. These plans are usually combined with other treatments, such as physical therapy. It is best to consult a medical professional before starting any medication or treatment.

Assistive Devices

Assistive devices are crucial for paraplegia management. Wheelchairs provide mobility, while braces and orthotics support weakened muscles and aid stability. Adaptive tools like reachers, dressing aids, and modified utensils enhance independence in daily tasks. These devices empower individuals to navigate their environment and maintain a more fulfilling life despite mobility challenges.

Surgical Interventions

Surgical interventions address Paraplegia by relieving spinal cord compression, repairing fractures, or correcting deformities. Procedures like decompression surgeries remove pressure on the cord, while stabilization surgeries ensure spinal stability. Surgical options are tailored to the underlying cause and aim to alleviate symptoms, enhance function, and improve overall quality of life.

Rehabilitation Centers

Rehabilitation centers play a vital role in paraplegia treatment, offering comprehensive programs to improve physical, functional, and emotional well-being. Skilled professionals, including physical and occupational therapists, work to enhance mobility, independence, and adaptive skills. These centers provide tailored exercise regimens, mobility training, assistive technology guidance, and psychological support. By focusing on holistic rehabilitation, individuals with Paraplegia can regain self-confidence and maximize their potential for a fulfilling life.

Common Risk Factors for Paraplegia

Various factors contribute to the likelihood of developing paraplegia, ranging from traumatic incidents to medical conditions and genetic predispositions.

• Traumatic incidents like automobile accidents, falls, and sports injuries leading to spinal cord damage
• Medical conditions such as spinal tumors, infections, and degenerative disorders
• Engaging in activities with a higher potential for spinal injuries, such as extreme sports
• Certain congenital conditions or genetic predispositions increasing the risk of developing paraplegia

Conclusion

Paraplegia is a type of paralysis that affects the lower half of your body. It affects your ability to walk, stand, and do other actions that require control of your legs, feet, pelvic muscles, and stomach.

Paraplegia is generally the result of an injury, but it can also be caused by conditions that damage your spinal cord or brain. There is no cure for paraplegia, but with comprehensive rehabilitation, adaptive strategies, and advancements in assistive technologies, many individuals can significantly improve mobility, independence, and overall quality of life.

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Overview

Hemiparesis or hemiplegia are the medical terms, for paralysis of one half of the body. Hemiplegia is a symptom of brain or spinal cord damage where as Hemiparesis refers to weakness in one leg, arm, or side of the face. Hemiplegia describes severe or complete unilateral loss of strength or paralysis. Both may result from a stroke and other conditions. Hemiparesis and hemiplegia may have the same cause, but depending on the severity and location of brain and spinal damage, you may develop one or the other.

Hemiparesis and hemiplegia are both inherently unpredictable, with symptoms that may change over time. Prompt intervention, including extensive physical therapy, can substantially improve the chances of a full recovery. Psychotherapy is also important, since the overwhelming nature of these injuries can interfere with a patient’s ability and willingness to stick with treatment.

Every patient is different, but there is no way to conclusively predict the prognosis of these disorders. Some people spontaneously recover, even with no treatment. Others make little progress, even with extensive treatment. In general, however, the more aggressively a patient works to recover some functionality, the more likely a full or partial recovery becomes.

Hemiparesis and Hemiplegia Causes

There are a number of conditions that can cause hemiparesis or hemiplegia. Examples of hemiparesis and hemiplegia causes include strokes, brain injuries, spinal cord injuries, infections, and a handful of other conditions affecting the central nervous system.

Both hemiparesis and hemiplegia are nervous system disorders, not caused by injury to the affected side of the body. For example, an injury to the spinal cord or brain interferes with the body’s ability to send or receive signals to the region of the body affected by the injury. So, while the left or right side of the body haven’t been damaged directly, the spinal cord injury may cause hemiparesis or hemiplegia.

The most common cause of both injuries is a stroke. Strokes interfere with blood flow to the brain. If a region of the brain that affects movement or perception is affected, hemiparesis or hemiplegia may develop. The affected region is usually the opposite of the side of the brain affected, so an injury to the right side of the brain will affect the left side of the body.

Some other causes of hemiparesis and hemiplegia include:

• Brain infections such as meningitis or encephalitis
• Brain cancer or lesions
• Damage to the neurons due to a degenerative disorder such as Parkinson’s
• Traumatic injuries, such as a blow to the head during a car accident
• Congenital disorders such as cerebral palsy

Rarely, psychological conditions can manifest as hemiparesis or hemiplegia. When this occurs, doctors must treat the psychological issue, not the physical symptoms.

Right Hemiplegia vs Left Hemiplegia

Left hemiplegia is the paralysis of limbs on the left side of the body, while right hemiplegia indicates paralysis on the right side of the body. Like hemiparesis, right or left hemiplegia may be caused by damage to the nervous system.

One common cause of left or right hemiplegia is an incomplete spinal cord injury. In an incomplete SCI, only part of the spinal cord is severed, so there may still be some function below the injury site. For example, an incomplete spinal cord injury in the cervical spinal cord might paralyze the left side of the body while leaving the right side functional — though this isn’t guaranteed because the specific nerves severed may alter the effects of the injury.

Right Hemiparesis vs Left Hemiparesis

As the name implies, right hemiparesis is weakness on the right side of the body, while left hemiparesis is weakness on the left side of the body. What causes this weakness in one side of the body and not the other varies, but damage to the nervous system from injury, infection, or degenerative conditions can result in hemiparesis.

In the case of degenerative conditions such as multiple sclerosis or amyotrophic lateral sclerosis (ALS), hemiparesis may progress into hemiplegia with time.

Did you ever thought why is only one side of the body affected?

Your spinal cord and brain have a left side and a right side. The halves are identical. Each half controls the movements on one side of the body.

An injury to one side of the spinal cord or brain may result in weakness or paralysis on the side of the body that half controls.

If you have multiple strokes on both sides of the brain, you may experience hemiparesis or hemiplegia on both sides of the body.

Symptoms of Hemiplegia & Hemiparesis

Hemiplegia is more severe than hemiparesis. It involves a complete loss of strength or paralysis (inability to move) on one side of the body. It may affect your arm, face, or leg only, or all of them.

Although the paralysis may not be extensive (whole body), it could affect your ability to:

• breath
• swallow
• speak
• control your bladder
• control your bowel
• move one side of your body

It’s common for hemiparesis to unevenly affect one side of the body. The disorder is on a continuum, with symptoms ranging from minor and sporadic to extensive and severe. signs include:

•  Difficulties with motor skills, particularly standing.
• Weakness in large areas on one side of the body. For example, a patient might be unable to lift his or her arms.
• Pusher syndrome: a common byproduct of traumatic brain injuries, pusher syndrome causes a person with hemiparesis to shift their weight to the affected side, thereby undermining motor skills and making walking difficult and potentially painful. Doctors use a scale to assess the severity of pusher syndrome. This scale can help doctors make accurate prognostications, in addition to identifying the cause of symptoms.
• Strain on the unaffected side of the body, which may overcompensate for injuries on the hemiparetic side.
• Unusual sensations or tingling on the affected side.

Importantly, doctors will look for injuries on the affected side to rule out other causes, such as pinched nerves, muscle strains, or loss of blood flow.

Diagnosing hemiparesis and hemiplegia

A doctor will most likely use a number of diagnostic procedures and imaging tests to diagnose hemiparesis and hemiplegia.

These might include:

• X-ray
• magnetic resonance imaging (MRI)
• computerized tomography (CT) scan
• electromyography (EMG)
• myelography (imaging test of your spinal cord)

Treatment for Hemiparesis and Hemiplegia

Though hemiparesis and hemiplegia produce different symptoms, they are substantially similar in cause and treatment. To treat either condition, a doctor will first look at what caused the symptoms. When an infection, growth, or other medical issue causes symptoms, a doctor may first address these symptoms. When a stroke is the culprit, the stroke itself cannot be reversed, but a number of treatments may help restore some or all functioning:

• Physical, occupational, or exercise therapy to restore functioning and help the brain work around the injury.
• Assistive devices such as walkers or wheelchairs.
• Occupational therapy to support independence.
• Psychotherapy to address the psychological impact of a severe injury.
• Alternative treatments such as acupuncture and dietary changes.

Conclusion

Though the symptoms are different, the two conditions are essentially different versions of the same underlying problem. Mild to moderate nerve or brain damage will produce hemiparesis, while moderate to severe nerve or brain damage will result in hemiplegia. Moreover, the same injury can produce both symptoms at different times. This is especially true when nerves are compressed or the spinal cord is swollen, since changes in swelling or compression can also produce changes in symptoms.

People living with hemiplegia  and hemiparesis usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation .

In addition to this if you or your loved ones are looking for medical opinion abroad feel free to email us the medical reports on query@gtsmeditour.com or you can WhatsApp us +91 9880149003

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Overview

Hemiplegia (hemi = half; plegia = paralysis), as the name suggests, literally means paralysis of half of the body, is a type of paralysis of the muscles of the lower face, arm, and leg on one side of the body. hemiplegia is further classified as right or left hemiplegia. Hemiplegia is usually caused by brain damage localized to the cerebral hemisphere opposite the affected side. The most common cause of hemiplegia is stroke, other causes of hemiplegia include trauma eg. spinal cord injury; brain tumours; and brain infections.  hemiplegia can be temporary or permanent. Some causes of hemiplegia are treatable or even reversible with immediate medical care.

Hemiplegia may appear soon after birth (i.e., up to approximately two years of life), where it is known as congenital hemiplegia, or hemiplegic cerebral palsy. On the other hand, acquired hemiplegia presents later in life as a result of injury or other pathology. People living with hemiplegia usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation therapists.

A person with hemiplegia can experience up to full paralysis on one side of their body and may have trouble speaking or breathing.

IMPORTANT: Hemiplegia is a key sign of a stroke, which is a life-threatening medical emergency. To recognize the symptoms of a stroke, remember to think FAST:

• F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of paralysis (facial hemiplegia) or muscle weakness.
• A is for arm. A person having a stroke often has muscle weakness or paralysis on one side. Ask them to raise their arms. If they have new one-sided weakness or paralysis, one arm will stay higher while the other will sag and drop downward, or won’t raise up at all.
• S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
• T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider about when the symptoms started can help them know what treatment options are best.

Conditions that cause hemiplegia

There are dozens of conditions and circumstances that can cause hemiplegia. Some of the most common causes include:

• Strokes or transient ischemic attacks (TIAs).
• Aneurysms and hemorrhages inside of your brain.
• Concussions and traumatic brain injuries (TBIs).
• Spinal cord injuries.
• Injuries you experience during birth or very early childhood, causing conditions like hemiplegic cerebral palsy.
• Congenital conditions (which you have when you’re born) such as alternating hemiplegia of childhood.
• Facial paralysis conditions like Bell’s palsy.
• Seizures and epilepsy.
• Bleeding in between your brain and its outer layers (subdural hematomas or subarachnoid hemorrhages) or between your skull and your brain’s outer membrane (epidural hematomas).
• Brain tumors (including cancers).
• Nervous system diseases, especially autoimmune and inflammatory conditions, such as multiple sclerosis or progressive multifocal leukoencephalopathy (PML).
• Infections that affect your nervous system, like encephalitis, meningitis or Ramsay Hunt syndrome.
• Migraine headaches (when these involve hemiplegia, they’re known as hemiplegic migraines).

Hemiplegia symptoms

Hemiplegia can affect either the left or right side of your body. Whichever side of your brain is affected causes symptoms on the opposite side of your body.

People can have different symptoms from hemiplegia depending on its severity. Symptoms can include:

• muscle weakness or stiffness on one side
• muscle spasticity or permanently contracted muscle
• Loss of motor function
• trouble walking
• poor balance
• trouble grabbing objects
• speech associated trouble.

Children with hemiplegia may also take longer to reach developmental milestones than their peers. They may also use only one hand when playing or keep one hand in a fist.

If hemiplegia is caused by a brain injury, the brain damage can cause symptoms that aren’t specific to hemiplegia, such as:

• memory problems
• trouble concentrating
• speech issues
• behavior changes
• seizures

Diagnosis

Hemiplegia is often diagnosed after reviewing the individual’s past medical history and performing a detailed neurological examination assessing sensory and motor functions.

Additional tests can be conducted in order to determine the underlying cause of hemiplegia. Blood tests, including a

Complete blood count (CBC)

Erythrocyte sedimentation rate (ESR)

Coagulation tests (e.g., PT, aPTT) can help eliminate various underlying causes, such as infections or malignancies.

Imaging, including magnetic resonance imaging (MRI)

Computerized tomography (CT) scans of the head, are necessary in order to exclude most pathologies, including strokes, aneurysms, brain tumors, multiple sclerosis, and injuries.

Lastly, electroencephalography (EEG), which measures the electrical activity of the brain, can be used for diagnostic purposes (e.g., reveal the part(s) of the brain from which seizures originate).

Types of hemiplegia

The following are movement disorders that can cause hemiplegia symptoms.

Facial hemiplegia

People with facial hemiplegia experience paralyzed muscles on one side of their face. Facial hemiplegia may also be coupled with a slight hemiplegia elsewhere in the body.

Spinal hemiplegia

Spinal hemiplegia is also referred to as Brown-Sequard syndromeTrusted Source. It involves damage on one side of the spinal cord that results in paralysis on the same side of the body as the injury. It also causes loss of pain and temperature sensation on the opposite side of the body.

Contralateral hemiplegia

This refers to paralysis on the opposite side of the body that brain damage occurs in.

Spastic hemiplegia

This is a type of cerebral palsy that predominately affects one side of the body. The muscles on the affected side are constantly contracted or spastic.

Alternating hemiplegia of childhood

Alternating hemiplegia of childhood usually affects children younger than 18 months old. It causes recurring episodes of hemiplegia that affect one or both sides of the body.

Hemiplegia symptoms

Hemiplegia can affect either the left or right side of your body. Whichever side of your brain is affected causes symptoms on the opposite side of your body.

People can have different symptoms from hemiplegia depending on its severity. Symptoms can include:

• muscle weakness or stiffness on one side
• muscle spasticity or permanently contracted muscle
• poor fine motor skills
• trouble walking
• poor balance
• trouble grabbing objects

Children with hemiplegia may also take longer to reach developmental milestones than their peers. They may also use only one hand when playing or keep one hand in a fist.

If hemiplegia is caused by a brain injury, the brain damage can cause symptoms that aren’t specific to hemiplegia, such as:

• memory problems
• trouble concentrating
• speech issues
• behavior changes
• seizures

Treatment

Treatment of hemiplegia involves a multidisciplinary approach. Healthcare professionals including physicians, physical therapists, occupational therapists, and psychologists must all contribute in order to assist affected individuals in regaining their functionality. Treatment typically aims at improving sensation and motor abilities so that individuals can perform their daily activities with as much independence as possible; as well as treating any underlying pathology causing the hemiplegia.

Physiotherapy

Working with a physiotherapist allows people with hemiplegia to develop their balance ability, build strength, and coordinate movement. A physiotherapist can also help stretch out tight and spastic muscles.

When hemiplegia isn’t temporary, healthcare providers often recommend rehabilitation in addition to other treatments. Rehabilitation can take place in a hospital (inpatient rehabilitation), clinic or office (outpatient rehabilitation), or at home. Rehabilitation generally includes:

• Physical therapy: Focused on leg function, standing, walking and balance.
• Occupational therapy: Focused on arm/hand function and other activities of daily life.
• Prescription of equipment, to enhance safety and the ability to function inside and outside of your home.
• Managing symptoms associated with hemiplegia, such as spasticity and depression.
• Guidance and resources to address the consequences of hemiplegia, for example, returning to work or applying for disability benefits.

Modified constraint-induced movement therapy (MCIMT)

Modified constraint-induced movement therapy involves restraining the side of your body unaffected by hemiplegia. This treatment option forces your weaker side to compensate and aims to improve your muscle control and mobility.

One small studyTrusted Source published in 2018 concluded that including mCIMT in stroke rehabilitation may be more effective than traditional therapies alone.

Assistive devices

Some physical therapists may recommend the use of a brace, cane, wheelchair, or walker. Using an assistive deviceTrusted Source may help improve muscular control and mobility.

It’s a good idea to consult a healthcare professional to find which device is best for you. They may also recommend modifications you can make to your home such as raised toilet seats, ramps, and grab bars.

Mental imagery

Imagining moving the paralyzed half of your body may help activate the parts of the brain responsible for movement. Mental imagery is often paired with other therapies and is rarely used by itself.

One meta-analysis looking at the results of 23 studies found that mental imagery may be an effective treatment option for regaining strength when combined with physical therapy.

Electrical stimulation

A medical professional can help stimulate muscular movement by using electrical pads. The electricity allows muscles that you can’t move consciously to contract. Electrical stimulation aims to reduce imbalances in the affected side of the brain and improve brain plasticityTrusted Source

Hemiplegia is Preventive when you..

• Pursue a healthy lifestyle (stop smoking, drink in moderation)
• Eat a balanced diet
• Attend scheduled check-up appointments
• Avoid exposure to extremes of temperature
• Try to avoid emotional stress
• Avoid physical fatigue
• Protect yourself against respiratory system infections

Conclusion

Hemiplegia is a severe paralysis on one side of your body caused by brain damage. It’s a non-progressive disorder and doesn’t get worse once it develops. With a proper treatment plan, it’s possible to improve the symptoms of hemiplegia.

If you’re living with hemiplegia, you can make the following changes to your lifestyle to aid your rehabilitation:

• Stay active to the best of your ability.
• Modify your home with assistive devices like ramps, grab bars, and handrails.
• Wear flat and supportive shoes.
• Follow your doctor’s recommendation for assistive devices.

Remember to think FAST

• F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of paralysis (facial hemiplegia) or muscle weakness.
• A is for arm. A person having a stroke often has muscle weakness or paralysis on one side. Ask them to raise their arms. If they have new one-sided weakness or paralysis, one arm will stay higher while the other will sag and drop downward, or won’t raise up at all.
• S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
• T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider about when the symptoms started can help them know what treatment options are best.

we provide free medical opinion abroad, we request you to provide us your latest medical reports on our email :query@gtsmeditour.com or whatsapp us on +91 9880149003.

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