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<p style='text-align:justify;'>}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of pakshaghata. [Cha.Sa. [[Chikitsa Sthana]] 53-55] Rehabilitation is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and occupational therapy. Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

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<p style='text-align:justify;'>}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of [[wikipedia:Hemiparesis|pakshaghata]]. [Cha.Sa. [[Chikitsa Sthana]] 53-55] [https://pubmed.ncbi.nlm.nih.gov/28157752/ Rehabilitation] is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476805/ occupational therapy.] Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

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==Causes ([[hetu]])==

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Aggravating factors of ([[vata dosha]]) lead to hemiplegia. These include following:

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Aggravating factors of ([[vata dosha]]) lead to [[wikipedia:Hemiparesis|hemiplegia]]. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

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The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

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The different pathologies like arteriosclerosis, aneurysms, and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or hemiparesis (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

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The different pathologies like [[wikipedia:Arteriosclerosis|arteriosclerosis]], [[wikipedia:Aneurysm|aneurysms]], and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or [[wikipedia:Hemiparesis|hemiparesis]] (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====

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*Increased serum cholesterol levels

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*Uncontrolled hypertension and diabetes mellitus

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*Uncontrolled hypertension and [[wikipedia:Diabetes|diabetes mellitus]]

*Improper management of infections and inflammation ([[ama]] sandharana)

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*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

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*electroencephalogram

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*[[wikipedia:Electroencephalography|electroencephalogram]]

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

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===Biomarkers for diagnosis and assessment of efficacy===

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Diffusion tensor imaging (DTI), diffusion-weighted imaging (DWI), T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), functional magnetic resonance imaging (fMRI), Magnetoencephalography (MEG), Positron emission tomography (PET), Transcranial magnetic stimulation (TMS) etc. are biomarkers used to measure the function.

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[[wikipedia:Diffusion_MRI|Diffusion tensor imaging (DTI)]], [[wikipedia:Diffusion_MRI|diffusion-weighted imaging (DWI)]], T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), [[wikipedia:Functional_magnetic_resonance_imaging|functional magnetic resonance imaging (fMRI)]], [[wikipedia:Magnetoencephalography|Magnetoencephalography (MEG)]], [[wikipedia:Positron_emission_tomography|Positron emission tomography (PET)]], [[wikipedia:Transcranial_magnetic_stimulation|Transcranial magnetic stimulation (TMS)]] etc. are biomarkers used to measure the function.

==Prognosis==

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'''Ⅰ. Acute condition'''

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Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion. Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered . ~~[D1]~~ Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure. Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

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Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion.

+

Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered. Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure.

+

Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

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