Left-sided hemiparesis in adults ICD code 10

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Left-sided hemiparesis is a type of cerebral palsy.
With such a serious illness, partial paralysis or impaired functioning of the right or left side of the body is observed. The disease develops as a result of certain disorders in motor neurons, which are located in the subcortex of the brain. There are four types of hemiparesis: upper, lower, and right-sided, left-sided. The type of cerebral palsy, which is characterized by the development of pathologies of the limbs of the same name, is called spastic hemiparesis.

With the development of left-sided hemiparesis, paralysis affects the left side of the body. Children experience impaired functioning of the limbs of the left side of the body (legs and arms). The arm muscles responsible for the flexion function are in good tone, and the tone of the lower extremities is observed in the extensor muscles. With such symptoms, children experience a “begging pose.”

Causes and risk factors

With the sudden onset of the disease, its causes are usually brain tumors, multiple sclerosis, ischemic or hemorrhagic stroke, encephalitis, diabetic encephalopathy, traumatic brain injury, migraine.

The causes of slowly developing hemiparesis can be: atrophy of the cerebral cortex, brain abscesses, radiation myelopathy, slowly progressing brain tumors.

Risk factors for the development of hemiparesis include stress - both constant or frequent, and strong one-time stress.

The cause of the development of the congenital form of hemiparesis is usually anomalies in brain development, fetal hypoxia, intrauterine or birth trauma.

Preventive recommendations

The development of left-sided paresis can be prevented by directing forces to the primary disease, which can lead to spastic changes in muscle and joint structures. We can only name preventive measures common to all diseases, namely:

1. Maintaining proper nutrition. By following a balanced diet, you can prevent atherosclerotic changes that increase the risk of stroke - the cause of hemiparesis. It is recommended to limit foods rich in cholesterol and animal fats. The diet includes vegetables and fruits, cereals, vegetable oil. Eating sea fish is beneficial because it contains unsaturated fatty acids that prevent damage to blood vessels.
2. Maintaining an active lifestyle. In this case, you can prevent obesity, weight gain, and arterial hypertension - serious risk factors. In addition, systematic exercise helps improve blood properties, reduce the risk of blood clots and stroke.
3. Elimination of bad habits. Ischemic stroke and its consequence – hemiparesis – can be prevented by eliminating smoking, which causes vasoconstriction and increases the risk of developing atherosclerotic changes.
4. Elimination of stressful situations. There is no need to be nervous or depressed, because this does not have the best effect on the state of the central nervous system. If you cannot solve the problem on your own, you need to consult a psychologist.

It is important to monitor your heart health and control your blood sugar levels. And, of course, if alarming symptoms are detected, you should not self-medicate. Only a doctor can make the correct diagnosis and prescribe effective treatment for hemiparesis.

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Forms of hemiparesis

Depending on the etiology, hemiparesis can be congenital or acquired.

Depending on the location of the primary brain injury:

• central - caused by damage to the pyramidal tract in the area from the cortex to the anterior horns of the spinal cord;
• peripheral - caused by damage to the nuclei of the cranial nerves or cells of the anterior horns of the spinal cord with their axons (cranial nerves or anterior roots of the spinal cord).

Usually hemiparesis occurs on the side opposite to the damage, which is caused by the decussation of nerve fibers at the junction of the medulla oblongata and the spinal cord.

By localization:

• right-sided hemiparesis – occurs more often, is typical for adults, and is often accompanied by speech disorders;
• left-sided hemiparesis - more common in children (it is one of the manifestations of cerebral palsy), often accompanied by mental disorders.

A separate form affecting the limbs is spastic hemiparesis.

Left-sided hemiparesis is one of the symptoms of cerebral palsy

According to the nature of the course:

• acute, or rapidly developing;
• subacute, or slowly developing.

By severity:

• easy;
• moderate;
• deep.

Symptoms

The clinical picture of hemiparesis depends on the location of the pathological focus and the degree of damage, and is very diverse.

Common symptoms of hemiparesis are prolonged headaches of varying intensity, fatigue, decreased appetite, weight loss, muscle and joint pain. Hemiparesis of central origin (which occurs most often) is characterized by fever, speech disorders, cognitive impairment, and seizures similar to epileptic ones.

Common symptoms of hemiparesis are headaches, fatigue, joint and muscle pain

With left-sided hemiparesis, the muscles of the left side of the body weaken; with the right-sided form of the pathology, the muscles of the right half of the body are affected. Motor disorders caused by muscle spasms occur 2-3 weeks after the onset of the disease and can increase throughout the year.

In the congenital form of the disease, as a rule, left-sided hemiparesis develops, which manifests itself in the first months of the child’s life. At the initial stages of the disease, weak active and passive movements of the limbs on the side of the pathology, asymmetrical movements of the upper and lower limbs, and a forced position of the hands are observed. There is a weak supporting function of the leg on the affected side of the body, impaired fine motor skills of the hand, incorrect posture, and scoliosis may develop. With severe hemiparesis, children may experience impaired intellectual abilities and mental abnormalities. Left-sided hemiparesis is often accompanied by impaired imagination, color perception, three-dimensional perception, and disorientation in space.

Risk factors for the development of hemiparesis include stress - both constant or frequent, and strong one-time stress.

Right-sided hemiparesis is often accompanied by disturbances in logical thinking, analytical abilities, and acalculia (impaired counting and counting operations).

Spasticity of the muscles on one side of the body is observed with the central nature of the pathology. In such patients, unilateral muscle hypertonicity is observed. Patients complain of muscle stiffness and impaired motor activity. In the peripheral form of the disease, there is a decrease in muscle tone (flaccid paresis), degenerative muscle atrophy, and pronounced trophic and vasomotor disorders.

In the case of focal brain damage, the patient experiences impaired motor function, as well as decreased sensitivity of the right or left half of the body. In this case, the lower limb on the affected side does not bend when walking, making a semicircular movement across the side. Such patients usually have a high likelihood of regaining motor function. In case of damage to nervous tissue or extensive hemorrhage, neurological disorders occur: speech and intellectual impairment, epileptic seizures, disturbances of perception, emotional response, personality disorders.

Pathogenesis of the disorder

Hemiparesis is a disease characterized by partial paralysis, which provokes weakening of muscle tissue on a certain side of the body. At the same time, the other side remains healthy.

This condition is a consequence of damage to the upper motor neurons, as well as their axons. In addition, there may be a disruption in the functioning of motor neurons. In most cases, this disease is of cerebral rather than spinal origin.

To determine the severity of the manifestations of the disease, you need to pay attention to the symptoms of focal damage to the cortex. To them

Wernicke-Mann gait in hemiparesis

include speech disorders, problems with making purposeful movements, and difficulties in perception. A person may also experience epileptic seizures, sensory disturbances, and cognitive disorders.

Individual brainstem lesions are characterized by a combination of ipsilateral lesions of the nerves located in the head with contralateral hemiparesis.

If a person has abnormalities in the structure of the body, the disease develops more rapidly.

In this case, the patient may experience postictal hemiparesis, which develops after a focal motor attack.

This disease is characterized by the presence of epileptic seizures, which affect the formation of a brain abscess or tumor.

Diagnostics

To make a diagnosis of hemiparesis, a collection of complaints and anamnesis, an objective examination of the patient, as well as instrumental studies are carried out, the volume and nature of which depends on the form of the pathology.

Muscle strength is assessed on a five-point scale adopted by the British Medical Research Council:

• 0 – no movement;
• 1 – weak muscle contractions;
• 2 – movements are carried out only in the horizontal plane;
• 3 – the limb rises in the absence of resistance;
• 4 – the limb rises with little resistance;
• 5 – movements are preserved in full volume and strength.

To identify the cause of hemiparesis, computed or magnetic resonance imaging, electromyography, and Dopplerography of the blood vessels of the brain are performed.

Instrumental examination - CT or MRI - helps to determine the cause of hemiparesis.

In children, the diagnosis of hemiparesis is established at one to one and a half years, when children begin to walk and movement disorders become more defined.

CEREBROVASCULAR DISEASES (I60-I69)

Included: with mention of hypertension (conditions listed in sections I10 and I15.-)
If necessary, indicate the presence of hypertension, use an additional code.

Excluded:

• transient cerebral ischemic attacks and related syndromes (G45.-)
• traumatic intracranial hemorrhage (S06.-)
• vascular dementia (F01.-)

Excludes: consequences of subarachnoid hemorrhage (I69.0)

Excludes: consequences of cerebral hemorrhage (I69.1)

Excludes: consequences of intracranial hemorrhage (I69.2)

Includes: occlusion and stenosis of the cerebral and precerebral arteries (including the brachiocephalic trunk) causing cerebral infarction

Excludes: complications after cerebral infarction (I69.3)

Cerebrovascular stroke NOS

Excludes: consequences of stroke (I69.4)

Included:

Excludes: conditions causing cerebral infarction (I63.-)

Included:

Excludes: conditions causing cerebral infarction (I63.-)

Excluded: consequences of listed conditions (I69.8)

Note. Category I69 is used to designate conditions listed in categories I60-I67.1 and I67.4-I67.9 as the cause of consequences that are themselves classified in other categories. The concept of “consequences” includes conditions specified as such, as residual effects, or as conditions that exist for a year or more from the onset of the causative condition.

Do not use for chronic cerebrovascular diseases, use codes I60-I67.

ICD-10 alphabetical indexes

External Causes of Injury - The terms in this section are not medical diagnoses, but rather a description of the circumstances under which the event occurred (Class XX. External Causes of Morbidity and Mortality. Heading Codes V01-Y98).

Medicines and chemicals - table of medicines and chemicals that have caused poisoning or other adverse reactions.

In Russia, the International Classification of Diseases

10th revision (
ICD-10
) was adopted as a single normative document for recording morbidity, reasons for the population’s visits to medical institutions of all departments, and causes of death.

ICD-10

introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997 No. 170

The release of the new revision (ICD-11) is planned by WHO in 2022.

Abbreviations and symbols in the International Classification of Diseases, 10th Revision

NOS

- without further clarification.

NEC

— not classified in other categories.

†

— code of the main disease. The main code in the dual coding system contains information about the underlying generalized disease.

*

- optional code. An additional code in the double coding system contains information about the manifestation of the main generalized disease in a separate organ or area of ​​the body.

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Treatment

Treatment of hemiparesis is most effective in the first year from the onset of neurological disorders.

For a mild form of hemiparesis, therapy consists of a course of physical therapy (may include gymnastics on a fitball, swimming, etc.). General and segmental massage, hydromassage, hippotherapy (treatment with horses), as well as hardening procedures are also indicated.

Drug therapy is prescribed as needed. Muscle relaxants, anticonvulsants, drugs that improve the trophism of nervous tissue and blood supply to the brain, including vitamin complexes (vitamin E, B vitamins) are used.

Hemiparesis can be complicated by a complete loss of muscle strength on the affected side of the body, i.e., the development of paralysis (hemiplegia).

Physiotherapy methods are effective in the treatment of hemiparesis: electrophoresis, ultrasound therapy, diadynamic therapy, reflexology, mud therapy. In order to prevent the formation of contractures of joints and muscles, they resort to physiological placement of the limbs using splints.

For mild forms of hemiparesis, therapeutic exercise courses are effective.

For social adaptation and normalization of the emotional state, a course of psychotherapy may be required. Speech disorders require sessions with a speech therapist.

In severe forms of the pathology, surgical intervention on the affected muscles may be required.