Overview Spastic hemiplegia is usually derived from flaccid hemiplegia, but in patients with subacute or chronic onset, it can progress to rigid hemiplegia without going through the flaccid phase. It is characterized by a marked increase in muscle tone. The extensor muscle group of the upper limb and the flexor muscle group of the lower limb are obviously paralyzed, and the muscle tone is significantly increased, so the upper limb is flexed, the lower limb is straightened, the fingers are flexed, and the passive straightened hand has a feeling of stiffness and resistance. This is the most common type of spastic hemiplegia. It is mostly inherited from AD. The clinical manifestations are very similar to those of peroneal muscular atrophy, but the knee reflex is hyperactive, the pathological signs are positive, and there is a spastic gait, often accompanied by bowed feet. 2. Ferguson-Critchley syndrome AD is inherited. The clinical features are spastic hemiparesis with extrapyramidal symptoms, middle-aged onset, extremity cone fasciculation signs, and diminished or absent Achilles tendon reflex. Extrapyramidal impairment is manifested by stiffness and involuntary movements of the extremities, little facial expression, or a forward gait. Coordination of the extremities is impaired, and the distal deep sensation of both lower extremities is reduced, and the superficial sensation is normal or slightly reduced. Ocular symptoms are mainly horizontal nystagmus, restricted lateral and vertical gaze, and pseudo-ocular muscle paralysis. Sjogren-Larsson syndrome is characterized by diffuse flushing, thickening and dryness of the skin at birth or shortly after birth, and exudation from large joints. 1~2 years old, neurological symptoms gradually appear, manifesting as delayed intellectual development and spastic hemiplegia or tetraplegia (lower limbs heavier than upper limbs), flexion or even contracture of limbs, with joint changes, posterior spinal protrusion, hyperactive tendon reflexes and pathological signs. There are often symptoms of pseudomyelitis such as dysarthria and dysphagia. 4, Behr syndrome Before the age of 10 years, there is a gradual decrease in visual acuity and visual field defects. The pale optic disc and atrophy of the papillary macular bundle are seen in the fundus of the eye. Later, bilateral lower limb spasms, dysarthria, distal muscle atrophy, impaired position perception, deformed feet, ataxia, hydrocephalus, cleft palate, etc. appear. Urinary retention is often caused by bladder sphincter weakness. The disease tends to die within 20 years of age if it is complete, while the tonus type has only mild vision loss and can have a normal life expectancy. This is the most severe type of spastic hemiplegia. 5. Adrenospinal peripheral neuropathy showing spastic paralysis, sensorimotor neuropathy and adrenal insufficiency. Examination 1.Peculiar postural examination The shoulder is seen to be elevated, the forearm is inward, the elbow and wrist joints are flexed. The fingers are flexed to the palmar side before hand rotation, and the thumb is highly inward. The lower limb on the paralyzed side is hyperextended, the hip joint is inward, the knee joint is straight, the ankle joint is inward, the toes are plantar flexed in the form of claw toes or horseshoe inversion, and the walking gait is circle-like. 2.Facial examination There is usually no paralysis above the eye fissure or only slight paralysis, the eyes are not tightly closed, the eyelash sign is positive, the force of the hemiplegic side can be found to be weak when shutting up with force, the angle of the mouth of the paralyzed side is biased to the lower outer side in the natural position, and the mouth is oblique oval when opening the mouth. 3.Limb examination The muscle tone of the limb on the paralyzed side is significantly increased, the movement of the limb is obviously weakened, and some patients may be completely unable to move or the forearm is inwardly retracted, showing paralysis of the extensor muscle group of the upper limb and the flexor muscle group of the lower limb, and the hand and foot are the most serious, and the upper limb is heavier than the lower limb. 4. Examination of increased muscle tone The upper limb of the paralyzed side is dominated by increased flexor tone, and the lower limb is dominated by increased extensor tone, and the passive movement resistance of the joints on the hemiplegic side is significant. The resistance strengthens with the increase of tension, and finally the resistance disappears, which is often referred to as the folding knife feeling and is mostly seen in cone bundle lesions. 5.Deep reflex hyperactivity examination Because of the lowering of the deep reflex threshold, the amplitude of reflex contraction of muscles is enhanced, and hyperactivity of biceps tendon reflex, triceps tendon reflex, flexor pollicis brevis reflex of upper limbs, knee tendon reflex and Achilles tendon reflex of lower limbs can be seen during the examination. 6, myoclonic examination When the knee tendon or Achilles tendon is pulled after a series of rhythmic contractions, it is caused by the sudden pressure on the extensor muscle of continuous passive stretch, often called patellar clonus, ankle clonus, wrist clonus, etc. 7.Pathological reflex examination Pathological reflexes can appear regardless of the cause of the damage to the cone bundle, such as the positive Hoffman’s sign in the flexor reflexes of the upper limbs and the positive Babinski’s sign in the extensor reflexes of the lower limbs. 8. Weakness or disappearance of superficial reflexes Weakness or disappearance of abdominal wall reflex and testicular reflex in hemiplegia caused by damage to the cone bundle. Treatment For the treatment of spastic hemiplegia, experts talk about: spastic hemiplegia is a degenerative lesion of the nervous system, which determines that traditional treatment methods cannot be effective for it. At present, the medical profession generally believes that the most effective treatment for spastic hemiplegia is cell infiltration repair therapy. It is an organic combination of biotechnology and medical technology. It is a kind of central nerve regeneration therapy that produces a series of biophysical stimulation and biochemical effects in the treated area, and has good curative effect, starting from various disciplines such as molecular genetics, cellular pathology, nano-pharmacology, biophysics, molecular immunology, medical psychology, etc.