CEREBRAL PALSY Flashcards
What is cerebral palsy?
Group of conditions affecting motor function and posture due to a non-progressive lesion of the developing brain.
What proportions of babies are affected by cerebral palsy?
2 in 1,000
What are the possible motor features of cerebral palsy?
Abnormal tone early infancy
Delayed motor milestones
Abnormal gait
Feeding difficulties
Persisting primitive reflexes
What are the associated non-motor features of cerebral palsy?
Learning difficulties (60%)
Epilepsy (30%)
Squints (30%)
Hearing impairment (20%)
What are the antenatal causes of cerebral palsy?
Antenatal (80%):
Cerebral malformation
Congenital infection (rubella, toxoplasmosis, CMV)
What are the intrapartum causes of cerebral palsy?
Intrapartum (10%):
Birth asphyxia
Trauma
What are the post-partum causes of cerebral palsy?
Postnatal (10%):
Intraventricular haemorrhage
Meningitis
Head-trauma
Hypoglycaemia
Hyperbilirubinaemia
What are the congenital infections that are known to be a risk factor for cerebral palsy?
Rubella
Toxoplasmosis
CMV
What are the types of cerebral palsy?
Spastic (70%): hemiplegia, diplegia (all four limbs but mostly arms) or quadriplegia (all four limbs but mostly legs)
Dyskinetic (10%)
Ataxic (10%)
Mixed (10%)
What are the features of spastic cerebral palsy?
Damage to pyramidal pathways causes increased limb tone, often due to intraventricular haemorrhage
Brisk deep tendon reflexes
Velocity dependent increase in tone - dynamic catch
Extensor palmar responses
May be preceded by period of hypotonia
What are the three main types of spastic cerebral palsy?
Hemiplegic
Quadriplegic
Diplegic
What are the features of hemiplegic spastic cerebral palsy?
Unilateral involvement of the arm and leg. The arm will often be more affected than the leg, with the face being spared.
Fisting of the hand
Flexed arm
Pronated forearm
Tiptoe walk - toe-heel gait
Often no history of hypoxic-ischaemic encephalopathy
What are the features of quadriplegic spastic cerebral palsy?
All four limbs affected.
Extensor posturing of the trunk
Poor head control
Low central tone
Associated with seizures, microcephaly and moderate/severe intellectual impairment
There may be a history of perinatal hypoxic-ischaemic encephalopathy
What are the features of diplegic spastic cerebral palsy?
All four limbs affected but legs a lot more than arms.
Hand function can be normal
Associated with preterm birth due to periventriculaar brain damage.
What are the features of dyskinetic cerebral palsy?
Damage to the basal ganglia or extrapyramidal pathways causes decrease in tone
Abnormal involuntary movements - chorea, athetosis and dystonia
Intellect often relatively unimpaired.
What is chorea?
Irregular, sudden and brief non-repetitive movements
What is athetosis?
Slow writhing movements occuring more distally such as fanning of fingers
What is dystonia?
Simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles giving a twisting appearance
What are the features of ataxic cerebral palsy?
Damage to the cerebellum or its pathways. Associated with genetic factors
Hypotonia
Poor balance
Uncoordinated movements
Delayed motor development
What are the management options for someone diagnosed with cerebral palsy?
MDT - physiotherapy is key
Treatments for spasticity include:
Oral diazepam
Oral and intrathecal baclofen
Botulinum toxin type A
Orthopaedic surgery
Selective dorsal rhizotom
Anticonvulsants and analgesia as required
You review a 7-year-old girl who has cerebral palsy. She is having ongoing problems with spasticity in her legs which is causing pain and contractures. On speaking to her mother you ascertain that she is having regular physiotherapy, using the appropriate orthoses and has tried oral diazepam in the past. Which one of the following treatments may she be offered to try and improve her symptoms?
Baclofen
Clozapine
Clonidine
Dantrolene
Glyceryl trinitrate
Baclofen
