Cerebral Palsy Flashcards
S3Q1
CP: Growth
head, trunk, extremities - when fastest
head - sizes (4), til when, from to
height - sizes (5), til when recumbent, adult
weight - birth (2) LBW VLBW ELBW micro, size (4), spastic diplegia vs. quadriplegia
- head: infancy
- trunk: infancy, adolescence
- extremities: 1y-puberty
head
- birth: 35cm, 4 mos: 41cm, 12 mos: 47cm, mature: 57cm
- til 3y, supraorbital ridge & glabella to occipital
weight
- birth: 3400, 2500-4500
- LBW: < 2500, VLBW: < 1500, ELBW: < 1000, micropremie: < 800
- birth: 3400, 5 mos: 2x, 12 mos: 3x, til adolescence: +2kg/yr
- spastic diplegia = LBW
- spastic quadriplegia = normal
height
- birth: 50cm, 12 mos: 75cm, 4y: 100cm, early school: +5cm/yr, prepubescence: 5-8cm/yr
- recumbent til 5y, 2x height at 2y = adult height
CP: Reflexes
primitive, tonic (5), midbrain (6)
structure
- primitive/spinal cord
- tonic/brainstem: ATNR, STNR, TLR, positive supporting, associated reactions
- midbrain/cortical: equilibrium, protective extension, opctic, NOB BOB BOH
CP:
age + otherwise, sx (2), d/t, structure
CSF - where produced + 2 extra locations
degrees (4)
- immature brain = < 2y, otherwise TBI
- sx: spastic, disuse atrophy
- d/t nonprogressive lesion
- watershed zone beside lateral ventricle in capillaries of germinal matrix
- CSF: made in lateral ventricle –> intraventricular foramen of monroe –> 3rd ventricle
degrees of intraventricular hemorrhage
- germinal matrix
- IV
- IV + dilation of ventricles
- IV + parenchymal hemorrhage = 90% neurological sequelae
CP: Types of Intraventricular Hemorrhage
type, involved zone, involved function, consequences (1.2.3.1.2)
paraspinal cortical injury
- (B) cortical zone
- proximal, UE>LE
- spastic quadriplegia
periventricular leukomalacia
- (B) white matter necrosis
- LE>
- spastic quad, spastic diplegia
focal and multifocal ischemic brain necrosis
- MCA, usually L>R
- motor function
- spastic diplegia, spastic hemiplegia, seizure
status marmoratus
- basal ganglia
- rarely in isolation
- choreoathetoid
selective neuronal necrosis
- most common variety of injury
- CN5&7
- mental retardation, seizure
CP: Factors
prenatal (3.5)
perinatal (8)
postnatal (2.4)
prenatal
- prematurity, fetal anoxia, Rh incompatibility
- maternal drugs, infection, alcohol, teratogens, eclampsia, inherited causes
perinatal
- asphyxia, birth injury, abnormal birth, neonatal distress, prolonged labor, placenta previa (placenta a kiddie), premature, < 800g
postnatal
- head trauma, battering
- infection, encephalopathy, tumor, vascular accident
CP: Types
topographic - plegia, UE vs. LE, gait
neurologic - types (3)
spastic - examples, describe hemiplegia (2G), describe quadriplegia (2G)
dyskinetic - examples (5)
- topographic: hemiplegia (UE>LE), ataxic = wide BOS
- neurologic: spastic (pyramidal), dyskinetic (extrapyramidal), mixed
spastic
- plegias
- hemiplegia = arm bent & hand spastic/floppy, tiptoe
- quadriplegia = head twist, inward knees legs feet
dyskinetic
- atethosis, ataxic, chorea, choreoathetoid, dystonia
CP: Types
spastic diplegia - other name, sx (3) + UE/LE, 1–>1, gait=(2), risk (2)
spastic athetoid - etiology (1=1), pathology, sx (1.3)
spastic diplegia/little’s disease
- sx: UMN sx in legs>arms, learning disabiltiy, seizure
- floppy infant (hypotonic) –> spastic
- scissoring gait = spastic ADD & PF
- (+) prematurity, periventricular leukomalacia
spastic athetoid
- eti: hyperbilirubin encepalopathy = jaundice
- patho: hypoxic basal ganglia
- sx: athetosis (slow writhing movements), triad of kernictus (sunset sign/no upward gaze, sensorineural hearing loss, changing BP)
CP: GMFCS & Ax
GMFCS (5)
Ax - good prog for amb (2), poor (1)
GMFCS
- I: limit in advanced gross
- II: limited in outdoor/community
- III: AD, limited in outdoor/community
- IV: self-mob c limits, kids use power outside
- V: self-mob c severe limits, use power & assist
Ax
- G amb: sit by 2y, obligatory reflexes bye at 18m
- P amb: can’t sit by 4y
