Cerebral Palsy

Question 1

Epidemiology

Answer 1

RARE,

2-6/1000 live births
Lower socio economic status + M = risk factor
diagnosis 1 year afterbirth due to failure to reach milestones

Question 2

Aetiology

Answer 2

damage to the immature brain. Most authorities agree this damage occurs up to the postnatal period but some classify cerebral palsy as damage occurring before the age of 3 years

due to underlying structural abnormality of the brain

Toxins/infections
prenatal factors 80%
Maternal factors include - previous miscarriage, thyroid disorder, long menstral cycle,hypertension, bleeding 3rd trimester
multiple gestation
Perinatal = birth aphyxia, prematurity
Postnatal = infection, intracranial heamorrhage
hypoxia/ischaemia

Question 3

Pathogenesis

Answer 3

depends on which part of the brian gets damaged

spastic syndrome >70 percent
UMN damage - mild/server motor function
May misalign jts,hemiplegia,paraplegia,quaraplegia
Toe walking typical

Dyskinetic syndrome = 20% basal ganglia involve
ment. Slow writhing involuntary movt - activated with voluntary action, abrupt, jerky, chorea - brief, abrupt, irregular, unpredictable, non-stereotyped movements “dance”

Ataxic

Question 4

Natural History

Answer 4

if managed lead a normal length life

Question 5

Symptoms

Answer 5

Epilepsy: up to 36% of children with cerebral palsy will have onset of seizures within the first year of life.

Feeding and nutrition: failure to thrive and malnourishment are common secondary to pseudobulbar palsy.

Bladder problems: incontinence and infections are common.

Bowel problems: constipation is common and results from a combination of poor mobility and poor oral intake.

Sleep disturbances: for example, fragmented sleep, which can occur in up to 50% of children.

Drooling: this may also result from pseudobulbar palsy.

Orthopaedic problems: for example, progressive joint contractures, shortened muscles, hip or foot deformities, scoliosis and fractures due to osteomalacia or osteoporosis, which are more common with increasing motor disability.

Non-motor problems:
Sensation and perception (tactile, vision, hearing).
Cognition (some relation to physical severity).
Communication.
Behaviour.

Question 6

Signs

Answer 6

as above

Question 7

Complications

Answer 7

Contractions.
Gastrointestinal symptoms and their sequelae - eg, reflux, oropharyngeal muscle disorders, failure to thrive and osteoporosis.
Pulmonary complications - eg, aspiration pneumonia and bronchopulmonary dysplasia.
Dental problems.
Moderate/severe learning difficulties (in 30-50% of patients associated with severe spastic quadriplegia).
Hearing loss (particularly seen where the secondary cause is hyperbilirubinaemia or exposure to ototoxic drugs).

Question 8

Prognosis

Answer 8

Most survive into adulthood. sever limitations
may decrease life expectancy
if managed = normal life