Main Article: Hemiplegia;

     65 years old hypertensive patient Complaining of sudden weakness of the right side of body and inability to move his right leg and right hand with no fever 7 days ago. Non diabetic, no history of trauma with positive family history of stroke (as I remembered).

        To understand and manage this case, need some basic knowledge about below;

There are very specific areas or regions in the human brain, one of these areas called Motor Area, which is responsible for movements of our body parts. The brain consists of nerve tissue including motor area. We move our peripheral extremities like hands movement, knees movement and shoulders movement But these movements are far from Brain, thus in order to reach to these parts, Motor Nerves descend from head to toes through first Internal Capsule then brain steam then upper part of medulla oblongata then lower part of medulla, ; in the upper part of medulla motor nerves Decussate into two side, right and left  within lower part of medulla(most important point in this case) and finally connect to the Spinal cord, from Spinal cord give branch to all peripheral extremities. Look at the picture to know the internal capsule and other parts of brain. Brain tissue

survive due to it has blood supply, which gives Oxygen and nutrition to brain tissue, like all others part of the body survived. Axial Nervous System like Brain and Spinal cords are called Central Nervous System. The branch nerves from Axial are called Peripheral Nervous Systems. All muscles of our body have nerve supply, we can divide all muscles into two parts; muscles that are in the half of right site of body and half of body muscle in the left site. Word half can be defined as Hemi. Weakness or paralysis of muscle called Plegia, If paralysis on one side of body muscle is called Hemiplegic due to nerve injury within from brain to the muscle involved.

Who causes the nerves to be injured?  Do you remember, only the Blood supplies to it make the nerves to be survived? Thus Obstruction of blood flow

to the nerve tissue injures the nerve tissue. Blood flow obstruction can be either in the brain or in the medulla or in the spinal cords. Second question,

Who obstructs the blood flow???

  It could be either Blood clot or thrombosis or emboli,  all of these due to atherosclerosis due to either old age ;aging, hypertensive, high cholesterol level, Diabetes due to blood sugar which damage the blood vessels or either hypo perfusion due to shock. Or either

ischemia to nerve tissue can cause the nerve to be injured.

    Any cause that injures the nerves tissue leads to the inability to move, if it is in the brain tissue is called Stroke due to any of the above reasons. Severity of paralysis depends on the extension of the brain tissue affected. remember the thrombosis or emboli could be the cardiac origin like Atrial Fibrillation here thrombosis is more common that travels to the brain blood vessels and obstructs vessels leads to ischemia of brain tissue including motor area of brain that causes the paralysis on one side of the body either right or left side of body depends on which side of brain is affected. Also speech disorder, blurred vision if area involved responsible for.

    Remember that motor nerves of brain separate at upper border of medulla, so if injured above it, paralysis occurred opposite side of body and if below it the paralysis on same side of body is called Contra lateral and ipsilateral paralysis consequently.

The nerves might be injured by either trauma to the head, or spine. Hemorrhage of the brain due to trauma also causes paralysis due to   from axial nerves.

brain nerves injured in ischemic way, or congenital like spina bifida due to embryonic neural tube defect. In this case, motor nerves injure or lesions named could be the Axial or upper motor neuron lesion and branch or lower motor neuron lesion ;branch

     From the complain, it is very clear that the case most probably the Hemiplegic due to stroke due to either thrombosis, or emboli due to atherosclerosis and patient known to have hypertensive. To confirm the diagnosis, need CT scan and MRI for both brain and spinal cord to see the lesions.

       What is the treatment of this patient?

In any case, treat the underlying cause, plus symptomatic, plus known past cause if needed, and plus non pharmacological. In this patient, underlying cause is thrombosis, so, Antiplatelet drugs, Symptoms are muscle weakness, so Physiotherapy, and for hypertensive, antihypertensive drugs. Remember the lesions are reversible without treatments; you should wait with monitoring, if disease progresses with time needs Treatments.