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Children's Health > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

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1
Q

What is the definition of global developmental delay?

A

A child has a global developmental delay if they have significant delay in milestones in at least 2 or more areas

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2
Q

What are the main causes of profound disability?

A
  1. Chromosomal abnormalities - micro-duplications and deletions
  2. Cerebral palsy
  3. Inborn errors of metabolism
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3
Q

What is cerebral palsy attributed to mostly?

A

Poor muscle tone (spasticity or rigidity)

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4
Q

What are the antenatal causes of CP?

A
  1. Maternal infections
  2. Trauma during pregnancy
  3. Prematurity
  4. Low BW
  5. Multiple gestation
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5
Q

What are the perinatal causes of CP?

A
  1. Birth asphyxia

2. Pre-term birth

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6
Q

What are the post-natal causes of CP?

A
  1. Meningitis
  2. Severe neonatal jaundice
  3. Head injury/NAI
  4. Cardio-pulmonary arrest
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7
Q

How would you define the following type of CP; Spastic?

A

Hypertonic patient with reduced function resulting from damage to upper motor neurones (UMN).

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8
Q

How would you define the following type of CP; dyskinetic?

A

Problems controlling muscle tone, with both hyper- and hypotonia. This causes athetoid movements and oro-motor problems (speech and eating repercussions). This is due to damage to the basal ganglia.

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9
Q

How would you define the following type of CP; Ataxic?

A

Problems in co-ordinating movements resulting from damage to the cerebellum.

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10
Q

What are the 3 types of CP?

A
  1. Spastic CP (UMN)
  2. Dyskinetic CP (basal ganglia)
  3. Ataxic CP (cerebellum)
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11
Q

What are some of the potential signs and symptoms of CP (these will become more evident as the child develops)?

A
  1. Failure to meet milestones
  2. Hypotonia or Hypertonia - general or in specific limbs
  3. Hand preference before 18 months old (KEY EXAM Q)
  4. Problems with co-ordination, speech or walking
  5. Feeding or swallowing problems
  6. Learning difficulties
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12
Q

What are the key features of Autism Spectrum Disorders (ASD)?

A
  1. Difficulties in communication
  2. Difficulties in social interaction
  3. Inflexible thinking
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13
Q

What sort of pathology is associated with CP?

A

Non-progressive, permanent

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14
Q

What are the protective factors of obstetric care against CP?

A
  1. Magnesium Sulfate
  2. Antibiotics
  3. Corticosteroids
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15
Q

What percentage of patients with CP had an antenatal cause for developing CP?

A

70-80%

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16
Q

There is a U shaped distribution of patients with CP, therefore which ages are most affected by CP?

A

Very premature and post-term babies

17
Q

What is the leading cause of CP in premature infants?

A

Periventricular Leukomalacia (PVL)

18
Q

What is Periventricular Leukomalacia (PVL)?

A

A condition of underdeveloped white matter in the brain

19
Q

What causes periventricular leukomalacia (PVL)?

A

There are 2 important mechanisms;

  1. Ischaemia/hypoxia
  2. Infection/inflammation
20
Q

What are the 2 main causes of CP due to prematurity?

A
  1. Periventricular leukomalacia (PVL)

2. Intraventricular haemorrhage (IVH)

21
Q

List the TORCHS infections.

A 
T - Toxoplasmosis 
O - Other infections (varicella zoster, adenovirus, enterovirus)
R - Rubella
C - Cytomegalovirus (CMV)
H - Herpes Simplex Virus (HSV)
S - Syphilis
22
Q

What are the common intrauterine infections that can cause CP?

A
  1. Chroioamnionitis

2. The TORCHS infections

23
Q

Why are preterm babies more at risk of periventricular leukomalacia (PVL)?

A

As they have poor auto-regulation of the cerebral blood flow which usually protects the foetal brain from hypo-perfusion due to underdeveloped arteriolar smooth muscle and immature vasoregulatory mechanisms

24
Q

What are Upper Motor Neurones (UMN)?

A

Neurones of the brain and spinal cord (CNS) that control movement of the muscles. This is one half of the somatic nervous system. The cell bodies of the UMN most originate int he cerebral cortex or the brainstem and must terminate within the brain stem or spinal cord.

25
Q

Where does an UMN synapse?

A

Onto the lower motor neuron (LMN), they are inhibitory of the LMN (bock the LMN activity).

26
Q

What are the 5 signs that can be elicited in someone with an UMN lesion on neurological examination?

A
  1. Hypertonia
  2. Hyperreflexia
  3. Spasticity - stiff and tight muscles on passive movement in a velocity dependent manner
  4. +ve Babinski Sign - dorsiflexion of the big toe and abduction of the other toes (only relevant in those aged 2 and above)
  5. Clonus present
27
Q

What is a Lower Motor Neuron (LMN)?

A

A multipolar neuron which connects the UMN to the skeletal muscle it innervates - passing from the ventral horn of the spinal cord grey matter and attaching to skeletal muscles (motor cranial nerves are also LMN).

28
Q

What are the 5 signs that can be elicited on a neurological examination of someone with a LMN lesion?

A
  1. Hyporeflexia/areflexia
  2. Hypotonia/atonia
  3. Flaccid muscle weakness or paralysis
  4. Fasciculations
  5. Muscle atrophy
29
Q

Which medications can be used to help manage increased tone in children with CP?

A
  1. Baclofen
  2. Diazepam
  3. Botulinum toxin
30
Q

What are the possible side effects of steroid use in children?

A
  1. Increased appetite - weight gain
  2. Behavioural deterioration
  3. Hypertension
  4. Growth Failure
  5. Gastrointestinal irritation
  6. Bone thinning

Children's Health (14 decks)

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