Cerebral Palsy

Question 1

Causes of Cerebral Palsy

Answer 1

Antenatal:

Maternal infections
Trauma during pregnancy

Perinatal:

Birth asphyxia
Pre-term birth

Postnatal:

Meningitis
Severe neonatal jaundice
Head injury

Question 2

Types of Cerebral Palsy

Answer 2

Spastic: hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones

Dyskinetic: problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.

Ataxic: problems with coordinated movement resulting from damage to the cerebellum

Mixed: a mix of spastic, dyskinetic and/or ataxic features

Question 3

Patterns of Cerebral Palsy

Answer 3

Monoplegia: one limb affected
Hemiplegia: one side of the body affected
Diplegia: four limbs are affects, but mostly the legs
Quadriplegia: four limbs are affected more severely, often with seizures, speech disturbance and other impairments

Question 4

Presentation of Cerebral Palsy

Answer 4

Failure to meet milestones
Increased or decreased tone, generally or in specific limbs
Hand preference below 18 months is a key sign to remember for exams
Problems with coordination, speech or walking
Feeding or swallowing problems
Learning difficulties

Question 5

Gaits

Answer 5

Hemiplegic / diplegic gait: indicates an upper motor neurone lesion
Broad based gait / ataxic gait: indicates a cerebellar lesion
High stepping gait: indicates foot drop or a lower motor neurone lesion
Waddling gait: indicates pelvic muscle weakness due to myopathy
Antalgic gait (limp): indicates localised pain

Patients with cerebral palsy may have a hemiplegic or diplegic gait. This gait is caused by increased muscle tone and spasticity in the legs. The leg will be extended with plantar flexion of the feet and toes. This means they have to swing the leg around in a large semicircle when moving their leg from behind them to in front. There is not enough space to swing the extended leg in a straight line below them.

They will have signs of an upper motor neurone lesion, with good muscle bulk, increased tone, brisk reflexes and slightly reduced power. Power may be normal. Look for athetoid movements that indicate extrapyramidal (basal ganglia) involvement. Test for coordination to look for cerebellar involvement.

Question 6

Treating Cerebral Palsy

Answer 6

Muscle relaxants (e.g. baclofen) for muscle spasticity and contractures
Anti-epileptic drugs for seizures
Glycopyrronium bromide for excessive drooling