Authors: Swati A Karmarkar, MD, Texas Children’s Hospital
Shruti Rane, PhD, Kennedy Kreiger Institute, Baltimore, MD

Reviewed: July 2021

SUMMARY

Hemiplegia involves paralysis or weakness of one side of the body. It is often due to a brain injury. An injury on one side of the brain can cause paralysis on the opposite side of the body. Signs of hemiplegia other than paralysis or weakness can include:

• Seizures
• Difficulties with speech
• Difficulties with fine motor skills
• Difficulties with cognitive functioning

Testing often includes a brain MRI. MRI stands for magnetic resonance image. MRIs can produce pictures of the brain.

Treatment involves:

• Managing underlying causes.
• Treating any associated conditions. Recurrent seizures, epilepsy is an example.
• Rehabilitation. This involves treating muscle tone abnormalities. It also involves therapies. Physical, occupational, and speech therapies are examples.

Disorder Overview

DESCRIPTION 

The term hemiplegia means paralysis (“plegia”) of one half (“hemi”) of the body. The term “hemiparesis” is sometimes also used. Hemiparesis refers to a milder weakness on one side of the body.

Severity varies from child to child. On one end is very mild weakness. On the other end is complete paralysis of one side of the body.

SIGNS AND SYMPTOMS 

Common Signs and Symptoms

Signs and symptoms can be subtle. They are sometimes missed. Generally speaking, signs of hemiplegia include:

• Differences in how a child uses left and right sides of body
• Favoring one hand at an early age in infancy before hand dominance is typically established (before age 12 months)
• Keeping one hand fisted
• Delayed walking
• Difficulty walking
• Difficulty with balance
• Tip-toe walking on affected side
• Spasticity (stiffness) or tightness in muscles on affected side
• Other abnormal muscle tone
• Symptoms of stroke such as:
  • One-sided facial droop
  • Slurred speech or loss of speech
  • Weakness on the affected side
  • Numbness on the affected side

Coexisting Conditions

Children may experience other conditions alongside hemiplegia. These added conditions are due to the injury that caused hemiplegia. They can include: 

• Seizures. Seizures may immediately follow brain injury. They may also take place remotely, months or years later. 
• Cognitive and academic difficulties.
• Speech/language concerns. This can mean trouble understanding speech. It can also mean trouble speaking.
• Sensory deficits. This might include changes to vision and decreased sensory perception on the affected side. 
• Behavioral or psychological symptoms.

CAUSES

Hemiplegia is caused by an abnormality or injury on one side of the brain. If the left side of the brain is affected, it can result in right-sided hemiplegia. If the right side of the brain is affected, it can result in left-sided hemiplegia.

Causes at Birth

There are numerous causes of hemiplegia in children. Many are linked to events around birth. This is known as the perinatal period. In these cases, the term hemiplegic cerebral palsy is often used. Various issues can affect the fetal or baby’s developing brain. Examples include:

• Stroke
• Brain malformations
• Injury due to prematurity 
• Injury due to lack of oxygen (hypoxic injury)
• Infections
• Brain Bleeding

Causes in Older Children

Hemiplegia can also begin in older children. Causes of hemiplegia in older children include: 

• Stroke
• Brain tumor
• Brain hemorrhage
• Brain infections 
• Physical trauma 

Causes of Temporary Hemiplegia

Temporary cases of hemiplegia are possible. They can result from:

• Seizure.
• Migraine.
• Transient ischemic attack. A temporary condition in which there is decreased blood flow or oxygen to the brain. May be due to a blood clot, spasm of the artery, or blood vessel malformation.

Hemiplegia and Stroke

Hemiplegia can be due to stroke. Often, what caused the stroke remains unclear. Causes of stroke can vary, but include:

• Genetic blood clotting disorders. These are inherited conditions. There are different types of blood clotting disorders:
  • Thrombosis. Increased risk of blood clots forming in blood vessels. 
  • Embolus. When a blood clot, typically in the heart or large vessels in the neck, breaks off, flows into the brain, and clots a blood vessel there. 
  • Hemorrhage. Bleeding due to one of two things. First, it may be due to having blood that is unable to clot correctly. Second, it can be due to an abnormal blood vessel formation in the brain that bleeds or ruptures more easily. 
• Congenital heart disease. This is something a child is born with. It can cause blood clots to dislodge in the heart. These clots can flow up into the brain’s blood vessels. This can result in an occlusion or blockage.

LABORATORY INVESTIGATIONS

Hemiplegia can involve several tests. They may need to be repeated on a case-by-case basis. However, frequent or repeat testing is usually not needed. 

Possible tests include:

TREATMENT AND THERAPIES

OUTLOOK

The predicted outcome for children with hemiplegia varies widely. Some things that can affect long-term outcome include:

• Underlying cause
• Extent and location of brain abnormality or injury
• Whether cognition and speech are also affected
• Degree of the muscle weakness

Brain injury is permanent. However, the brain can form new connections and pathways. This is known as plasticity. Plasticity means that bodily functions may be regained or relearned over time. Therapies can help with plasticity. 

Many children with hemiplegia gain the ability to walk independently. Many can attend regular classrooms. And later, many will also function independently as adults.

Possible Lifelong Challenges

Depending on the underlying cause and other factors, hemiplegia can mean lifelong difficulties. These can affect the way children perform in the classroom and community. 

Milder difficulties might include:

• Fine motor concerns
• Mild gait abnormalities
• Problems finding words
• Issues with attention span

More severe difficulties might affect:

• Intellectual reasoning
• Executive functioning (the skills needed to achieve a goal)
• Academic functioning

Continuing Support

It can be helpful to have a formal plan for support and education. This plan can be based on the child’s specific needs. It can help with academic progress. Support might include:

• A Section 504 plan
• An individualized education plan (IEP)

RELATED DISORDERS

Related disorders include:

• Hemiplegic cerebral palsy. Hemiplegia is often the result of a brain injury that occurred in utero, during birth, or in early infancy. These children may be diagnosed with hemiplegic cerebral palsy. 
• Alternating hemiplegia of childhood. This is a rare genetic condition. It can cause returning episodes of weakness, paralysis, or other symptoms. These episodes can alternate sides of the body. This condition typically begins in infancy. Episodes are more common in infancy and childhood. However, they can persist into adolescence and adulthood.

Research 

These are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details. 

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 

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