Blood Pressure and Paralysis: Stroke as the Link, Not BP Directly

Blood pressure itself does not directly cause paralysis. However, hypertension is the leading risk factor for stroke, and stroke is a major cause of paralysis.

Mechanism

• Hemorrhagic stroke: Chronic HTN → lipohyalinosis/microaneurysms (Charcot-Bouchard) → intracerebral hemorrhage → motor cortex/basal ganglia/internal capsule damage → contralateral hemiplegia.
• Ischemic stroke: HTN accelerates atherosclerosis (large vessel) and small vessel disease (lacunes) → thromboembolism → infarction of motor pathways.

Other Paralysis Causes

• Spinal cord injury/compression (trauma, tumor, abscess, epidural hematoma).
• Guillain-Barré syndrome, transverse myelitis.
• Motor neuron disease (ALS).
• Peripheral nerve injury.
• Conversion disorder (functional neurological symptom disorder).

Clinical Pearl

Acute severe hypertension (e.g., >180/120 with end-organ damage) requires controlled reduction to prevent stroke. Chronic HTN management is primary stroke prevention.