Cerebral palsy Flashcards
Cerebral palsy
Group of conditions affecting motor function and posture due to a non-progressive lesion of the developing brain
Cause unknown
Antenatal risk factors
80%
Cerebral dysgenesis
Congenital infections: rubella, CMV, toxoplasmosis
Intrapartum risk factors
10%
Birth asphyxia
Postnatal
10%
Preterm birth: hypoxic-ischaemic encephalopathy, intraventricular haemorrhage
Hyperbilirubinaemia
Hypoglyceamia
Head injury
Intracranial infection: meningitis, encephalitis
Clinical features
Although lesion non-progressive, clinical manifestations evolve as nervous system develops
Patients often have problems in addition to movement and posture suggesting wide-spread damage
Hx of risk factors
Developmental delay
Delayed motor milestones
Abnormal tone and posturing in infancy
Feeding difficulties - oromotor coordination
Speech and language delay
Diagnosis
Clinical, more than one of:
Hyper or hypotonia
Power (delay in motor milestones)
Reflexes - brisk or absence or persistence of primitive
Abnormal movements (eg athetosis or chorea)
Abnormal posture or gait
Spastic CP
70% Damage to pyramidal pathways Increased limb tone aka spasticity (may be preceded by hypotonia) Brisk deep-tendon reflexes Extensor plantar response Further classification: Hemiparesis Diplegia: all limbs, legs more than arms Quadriplegia: all limbs, arms more than legs. Often truncal involvement, seizures and intellectual impairment
Ataxic CP
10% Damage to cerebellum or its pathways Early hypotonia Poor balance Uncoordinated movements Delayed motor development
Dyskinetic CP
10% Damage to basal ganglia or extrapyramidal pathways Hypotonia Delayed motor development Abnormal involuntary movements
Management
MDT Help with hypertonia: physio, muscle relaxant (eg baclofen), botox injections, surgical intervention Orthopoesic intervention (braces, shoes, surgery) Attention to associated problems (sensory deficit, learning difficulties, epilepsy)
