Cerebral Palsy Flashcards
Is cerebral palsy progressive or nonprogressive?
It is nonprogressive and static
If the symptoms of CP occurs after age of 2, what is it called?
Acquired brain injury
CP is most common cause of motor impairment in children? true or false?
True, it affects 2/1000 live births.
What is the antenatal cause of CP?
Accounts for 80% is antenatal due to cerebrovascular hemorrhage or ischemia, cerebral migration disorders or structural maldevelopment of the brain during gestation.
What is the causes during or befory delivery?
it accounts for 10% of the cases and are due to hypoxic-ischemic injury before or during delivery.
What is the postnatal cause of CP?
meningitis/encephalitis/ encephalopathy, brain trauma, hypoglycemia, hydrocephalus and hyperbilirubinemia.
What are the clinical presentation of CP?
- 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
What are the catagory of CP?
Spastic: bilateral, unilateral, not specified (90%).
Dyskinetic (6%)
Ataxic (4%)
Other
Where is the damage in spastic cerebral palsy?
Upper motor neurone (pyramidal or corticospinal tract) pathway.
What does it meen that the tone in spasticity is velocity dependent?
the faster the muscle is stretched the greater the resistance it will have.
What is a clasp knife response?
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.
What are the three main types of spastic CP?
Unilateral (hemiplegia), Bilateral (quadriplegia) and Bilateral (diplegia).
What characterized Unilateral (hemiplegia) type of CP?
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.
Affected limbs in unilateral may be Flaccid and hypotonic? True or False?
True, but after a while increased tone is predominant.
How is the medical history?
Usually normal which gives rise to the possibility of prenatal cause, which is often silent.
What characterized Bilateral (quadriplegia) CP?
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.
What is the common cause of Bilateral (quadriplegia) CP?
Usually a perinatal hypoxic-ischemic encephalopathy.
What is the characteristic features of Bilateral (diplegia)?
It affects all limbs but legs more than hands making the hands function seem normal. Walking is abnormal..
Which motor neurons is damaged in quadriplegia?
Both upper and lower motor neurons
What is the common cause of diplegia?
Preterm birth due to periventricular brain damage. The MRI may show periventricular leukomalacia.
Define dyskinesia
Dyskinesie refers to movement that are uncontrolled, involuntary and often evident with active movement or stress.
What are Chorea, Athetosis and dystonia? and which type of cerebral palsy do you find it?
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
What characterizes Dyskinetic cerebral palsy?
floppiness, poor trunk control and delayed motor development in infancy, and abnormal movements occuring at end of first year.
What are of the brain is damaged in Dyskinetic CP?
Basal ganglia
What is the most common cause of Dyskinetic CP? and what can MRI show?
hypoxic-ischemic encephalopathy at term. MRI scan can show bilateral changes predominantly in the basal ganglia.
What are the characteristics of Ataxic (hypotonic) cerebral palsy?
early trunk and limb hypotonia, poor balance, delayed motor development, incoordinated movements, intention tremor and ataxic gait.
How do we treat hypertonia in CP?
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.
