Case 28 Flashcards
What are key history findings in an 18 mo with cerebral palsy?
Premature birth, Gross motor delay, Language delay, Normal social and fine-motor development, Positive family history of infant death.
What are key findings in the physical exam of an 18 mo with cerebral palsy?
Increased tone and reflexes in lower extremities.
What is on the differential diagnosis with cerebral palsy?
Genetic abnormality, Metabolic disorder, Normal variant, Neurocognitive disorder, Cerebral palsy, Myopathy, Autism/Pervasive developmental disorder, Reaction to psychosocial stress
What is seen on an MRI of a toddler with cerebral palsy?
MRI of the brain shows irregularly shaped ventricles and increased FLAIR signal (indicating periventricular leukomalacia) and thinned corpus callosum.
Prematurity and development:
Infants born prematurely (less than 37 weeks) are at risk for many difficulties that may affect their development, including those listed below. The number and severity of problems generally correlates with decreasing gestational age. These problems include:
- Bronchopulmonary dysplasia
- Retinopathy of prematurity
- Hyperbilirubinemia
- Periventricular leukomalacia (PVL)
What is bronchopulmonary dysplasia?
- May cause poor growth due to increased caloric requirements, pulmonary infections, or congestive heart failure
- May necessitate prolonged or repeated hospitalization
What is retinopathy of prematurity?
Visual impairment may affect development, depending on the degree.
Hyperbilirubinemia:
- Potential neurotoxin
- Kernicterus is characterized by abnormal motor development and sensorineural hearing loss
Periventricular leukomalacia (PVL):
- Damage to white matter surrounding the ventricles resulting from hypoxia, ischemia, and inflammation
- PVL with cysts is highly correlated with cerebral palsy
What is the definition of Cerebral palsy?
Cerebral palsy (CP) refers to a group of non-progressive motor control disorders. Historically, the different types of cerebral palsy have been grouped together because they all involve motor abnormalities and are treated somewhat similarly. These disorders often include spasticity, exaggerated tendon jerks, and clonus.
Spastic quadriplegia cerebral palsy:
Involves entire body.
Etiology: Global brain abnormalities.
Various clinical scenarios.
Spastic diplegia cerebral palsy:
Involves legs more than arms.
Etiology: Periventricular white matter abnormality.
Clinical scenarios: Premature infants.
Dyskinetic cerebral palsy (athetoid, dystonic):
Variable pattern of involvement, often entire body.
Etiology:
Basal ganglia, cerebellar, and/or thalamus abnormalities.
Clinical scenarios: Perinatal asphyxia, kernicterus.
(Spastic) hemiplegia cerebral palsy:
General pattern of involvement: Arm and leg on one side.
Etiology: Unilateral upper motor neuron abnormalities.
Clinical scenario: Stroke.
Ataxic cerebral palsy:
Involves entire body.
Etiology: Cerebellar abnormalities.
Clinical scenario: Cerebellar hypoplasia, pontocerebellar hypoplasia.
Spastic diplegia:
Characterized by increased tone, predominantly in the lower extremities. Its incidence is greatly increased in premature infants.