Cerebral Palsy

Question 1

Define

When it usually presents?

Answer 1

Non-progressive lesion of motor pathways in the brain

Presents in infancy - < 2yrs

Question 2

What cerebral palsy causes?

Answer 2

Disorder of movement and posture
Also affects other developmental domains
Global developmental delay

Question 3

Causes:

In-utero

Birth

Neonatal

Answer 3

Vascular occlusion
Cortical malformation 
Maternal infection 
Prematurity 
LBW

Hypoxic injury

Infection

Question 4

Sub types - name all 3

Answer 4

Spastic CP

Ataxic hypotonic CP

Dyskinetic CP

Question 5

Spastic CP - presentation

Answer 5

Initial hypotonia then specific hemiplegia, quadriplegia or diplegia (usually in legs)

Question 6

Ataxic hypotonic CP - presentation

Answer 6

Initial hypotonia then incoordination, intention tremor and ataxic gait

Question 7

Dyskinetic CP - presentation

Answer 7

Chorea

Athetosis

Question 8

S+S

General

Answer 8

• Neonate with abnormal tone or posture.
• Persistent primitive reflexes.
• Missed motor milestones.
• Hyper-reflexia.

Question 9

S+S

Legs

Answer 9

• Abnormal gait.
  
  • Tiptoe walking.
  • Leg scissoring.

Question 10

S+S

Hands

Answer 10

• Asymmetric hand function under 12 months.

* Hand fisting.

Question 11

S+S

Later signs

Answer 11

• Joint contractures.
  
  • Hip subluxation.
  • Scoliosis

Question 12

S+S

Later signs

Answer 12

• Intellectual disability (50%).
  
  • Epilepsy (40%).
  • Strabismus (30%) and visual impairment.
  • ENT: speech problems (30%), hearing impairment (10%), drooling.
  • GI and GU: feeding difficulty (slow eating, gagging), GORD, vomiting, bowel and bladder dysfunction.
  • Psychological: sleep problems, mental health problems.

Question 13

How is a diagnosis made?

What can be used if it is not clear

Answer 13

Clinical

MRI

Question 14

Management:

Supportive:

Who is involved in child development MDT?

What aids and adaptations can be given?

Answer 14

Physio
OT
Speech and language

Wheelchairs
Hoists
Orthoses
Feeding tubes

Question 15

Management:

What should be managed medically?

How is the spasticity managed?

How is the drooling managed?

Answer 15

Manage most problems (epilepsy, GI and GU dysfunction, visual problems) as in any child

Baclofen PO, diazepam PO, botulinum IM

Anti-cholinergics - glycopyrronium bromide PO

Question 16

Management:

What can be done surgically?

Answer 16

Release of fixed contractures.

Selective dorsal rhizotomy – division of sensory nerve roots – for lower limb spasticity.