Cerebral Palsy Flashcards
What is cerebral palsy (CP)?
Describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary MSK problems.
At what ate is the diagnosis made?
Age 2, at most 3
What are the key points of the definition of CP?
Non-Progressive Lesion
Immature brian
Disorder of posture, movement, and sensation
What are the three time frames when CP is caused? What percentage of CP occurs during each?
Prenatal (35%)
Perinatal (35-40%) - right around birth/during the birth process
Postnatal (4-6%)
- There is a high percentage of cases that time of lesion can not be determined*
What are the prenatal causes of CP?
Early - genetic or acquired impairments
Later: infectious or hypoxic-ischemic mechanisms that result in lesions
What are perinatal causes of CP?
Obstructed labor, cord prolapse, hypoxic-ischemic encephalopathy, neonatal stroke, severe hypoglycemia, untreated jaundice, severe neonatal infection
What are postnatal causes of CP?
Metabolic encephalopathy
Infections
Cerebral vascular eves - esp. first 28 days after birth
Injuries: near-downing, trauma, MVA, shaken baby syndrome
Lung disease requiring mechanical ventilation
What are risk factors for CP at birth?
Low birth weight
Prematurity
Poor intrauterine growth
Low APGARS
What are APGAR scores?
A quick test performed on a baby at 1 and 5 minutes after birth. Determines how well the baby tolerated the birthing process (1 min) and how well the baby is doing outside the womb (5 min)
Lower score is worse (out of 10)
What are the 5 categories of the APGAR score?
Breathing effort Heart Rate (most important assessment!) Muscle tone Reflexes Skin color
What is considered a normal APGAR score?
7, 8, or 9. A score of 10 is unusual typically lose one point for blue hands/feet which is common.
Any core below 7 is a sign that the baby needs medical attention.
What are LBW, VLBW, and ELBW?
Low Birth weight = < 2500g
Very low birth weight = < 1500g
Extremely low birth weight = <1000g
What is commonly seen with approximately 50% of surviving children with ELBW?
Subsequent moderate to severe neurodevelopment disabilities.
What are three types of lesions found in children with CP?
- Pervientricular leukomalacia (PVL) - ischemic
- Focal germinal matrix intraventricular hemorrhagic lesions (GM_IVH)
- Diffuse hypoxic ischemic encephalopathy (HIE)
What is a periventricular leukomalacia lesion? What are the associated characteristics?
- Leading known cause of CP and cognitive impairments in premature infants
- White matter damage
- Usually symmetrical, bilateral nonhemorrhagic lesion caused by ischemia
- Cellular necorsis (sometimes there is calcification seen) and cavitation around the ventricles
What areas are effected by periventricular leukomalacia lesions?
Can effect multiple areas of primary motor cortex
- Closer the lesion is to the center of the brain the more LEs are effected
- More extensive lesion results in greater involvement of the trunk and UEs
What is a subependymal germinal matrix/intraventricular hemorrhagic lesion? What are the associated characteristics?
- Most common type of brain lesion in the premature infant
- Neonates < 32 weeks, <1500g
- Starts in the germinal matrix and extends into the intraventricular space of lateral ventricles
What is the Germinal Matrix?
- Very fragile area during 2nd trimester
- Source of germinal cells for the cerebrum
- Premature infant poor auto-regulation of blood pressure
How is a subependymal germinal matrix/intraventricular lesion graded?
Graded I-IV by severity level
Grade I = isolated to germinal matrix
Grade IV = hemorrhage that involves ventricles and periventricular white matter
What are complications associated with subependymal germinal matrix/intraventricular lesions?
Hydrocephalus
Cyst formation
What is hydrocephalus?
The excessive accumulation of CSF resulting in an abnormal widening of spaces in the ventricles. This widening creates potentially harmful pressure on the tissues of the brain.
What does a grade IV subependymal germinal matrix/intraventricular lesion look like? What else is it referred to as?
- Sometimes referred to as Perventricular Hemorrhagic Infarction (PHI)
- Large region of hemorrhagic necrosis in the periventricular white matter
- Impeded venous return leading to increased pressure and rupture
- 35-90% have significant neurological conditions
What is hypoxic ischemic encephalopathy (HIE)?
- Lack of O2 and substrate delivery to the brain from decreased blood flow
- High neonatal mortality and neurologic morbidity
What are clinical signs of hypoxic ischemic encephalopathy (HIE)?
Lethargy Decreased activity Hypotonia Weak suck Incomplete Moro Bradycardia
What are associated factors/comorbidities of HIE?
Cognitive delays Behavioral issues Speech difficulties Auditory problems Seizure disorders/Epilepsy Visual Problems Urinary incontinence Constipation Sensory Impairment Growth disturbances Sleep disturbances
What is seen with 30+% of children with moderate HIE?
Spastic quadriparesis and cognitive impairment is common with this lesion
What are types of CP classified by topographic distribution?
Diplegia
Hemiplegia/Hemiparesis
Quadriplegia/Tetraplegia
What is diplegic CP?
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