Cerebral Palsy

Question 1

Is cerebral palsy progressive or nonprogressive?

Answer 1

It is nonprogressive and static

Question 2

If the symptoms of CP occurs after age of 2, what is it called?

Answer 2

Acquired brain injury

Question 3

CP is most common cause of motor impairment in children? true or false?

Answer 3

True, it affects 2/1000 live births.

Question 4

What is the antenatal cause of CP?

Answer 4

Accounts for 80% is antenatal due to cerebrovascular hemorrhage or ischemia, cerebral migration disorders or structural maldevelopment of the brain during gestation.

Question 5

What is the causes during or befory delivery?

Answer 5

it accounts for 10% of the cases and are due to hypoxic-ischemic injury before or during delivery.

Question 6

What is the postnatal cause of CP?

Answer 6

meningitis/encephalitis/ encephalopathy, brain trauma, hypoglycemia, hydrocephalus and hyperbilirubinemia.

Question 7

What are the clinical presentation of CP?

Answer 7

• abnormal limb and/or trunk posture and tone in infancy with delayed motor milestones
• feeding difficulties, with oromotor incoordination, slow feeding, gagging and vomiting
• abnormal gait once walking is achieved
• asymmetric hand function before 12 months of age

Question 8

What are the catagory of CP?

Answer 8

Spastic: bilateral, unilateral, not specified (90%).
Dyskinetic (6%)
Ataxic (4%)
Other

Question 9

Where is the damage in spastic cerebral palsy?

Answer 9

Upper motor neurone (pyramidal or corticospinal tract) pathway.

Question 10

What does it meen that the tone in spasticity is velocity dependent?

Answer 10

the faster the muscle is stretched the greater the resistance it will have.

Question 11

What is a clasp knife response?

Answer 11

Clasp-knife response refers to a Golgi tendon reflex with a rapid decrease in resistance when attempting to flex a joint, usually during a neurological examination. It is one of the characteristic responses of an upper motor neuron lesion.

Question 12

What are the three main types of spastic CP?

Answer 12

Unilateral (hemiplegia), Bilateral (quadriplegia) and Bilateral (diplegia).

Question 13

What characterized Unilateral (hemiplegia) type of CP?

Answer 13

More often hands are affected than legs. Face is spared. Fisting of affected hand, flexed arm, pronated forearm, asymmetric reaching, tiptoe walk (toe-heel gait) on affected side.

Question 14

Affected limbs in unilateral may be Flaccid and hypotonic? True or False?

Answer 14

True, but after a while increased tone is predominant.

Question 15

How is the medical history?

Answer 15

Usually normal which gives rise to the possibility of prenatal cause, which is often silent.

Question 16

What characterized Bilateral (quadriplegia) CP?

Answer 16

It is often severe, involves trunk with a tendency to opisthotonus (extensor posturing), poor head control and low central tone. Usually involves seizure, microcephaly, and severe intellectual impairment.

Question 17

What is the common cause of Bilateral (quadriplegia) CP?

Answer 17

Usually a perinatal hypoxic-ischemic encephalopathy.

Question 18

What is the characteristic features of Bilateral (diplegia)?

Answer 18

It affects all limbs but legs more than hands making the hands function seem normal. Walking is abnormal..

Question 19

Which motor neurons is damaged in quadriplegia?

Answer 19

Both upper and lower motor neurons

Question 20

What is the common cause of diplegia?

Answer 20

Preterm birth due to periventricular brain damage. The MRI may show periventricular leukomalacia.

Question 21

Define dyskinesia

Answer 21

Dyskinesie refers to movement that are uncontrolled, involuntary and often evident with active movement or stress.

Question 22

What are Chorea, Athetosis and dystonia? and which type of cerebral palsy do you find it?

Answer 22

Chorea: Irregular, sudden and brief non-repetitive movements.
Athethosis: slow writhing movements occuring more distally such as fanning of the fingers
Dystonia: simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles often giving a twisting appearance.
In dyskinetic cerebral palsy

Question 23

What characterizes Dyskinetic cerebral palsy?

Answer 23

floppiness, poor trunk control and delayed motor development in infancy, and abnormal movements occuring at end of first year.

Question 24

What are of the brain is damaged in Dyskinetic CP?

Answer 24

Basal ganglia

Question 25

What is the most common cause of Dyskinetic CP? and what can MRI show?

Answer 25

hypoxic-ischemic encephalopathy at term. MRI scan can show bilateral changes predominantly in the basal ganglia.

Question 26

What are the characteristics of Ataxic (hypotonic) cerebral palsy?

Answer 26

early trunk and limb hypotonia, poor balance, delayed motor development, incoordinated movements, intention tremor and ataxic gait.

Question 27

How do we treat hypertonia in CP?

Answer 27

botulinum toxin injection in the muscle, selective dorsal rhizotomy (a portion of nerve roots in spinal cord are selectively cut to reduce spasticity), intrathecal baclofen (a skeletal muscle relaxant) and deep brain stimulation of the basal ganglia.