Cerebral Palsy Flashcards
Definition
- A group of permanent disorders of movement and posture causing activity limitation
- Resulting from non-progressive lesions to the developing fetal or infant brain
• Affecting mainly the motor centers; cerebral cortex , cerebellum , and basal ganglia
🌺 If the brain injury occurs after the age of 2 years, it is diagnosed as acquired brain injury.
frequent neurologic associations including:
• Mental retardation
Epilepsy
- Impaired hearing ;deafness
- Impaired vision
- Emotional disturbances
- Behavioral disturbances
Causes
🤕 Pre-natal (80%)
- Antenatal Infections
- Congenital malformations
- Fetal asphyxia
🤕 Natal (10%)
- Birth asphyxia
- Birth trauma
🤕 Post-natal (10%)
- VLBW with intracranial hemorrhage
- Meningitis, encephalitis
- Metabolic e.g. phenyle ketonuria Hypoglycemia
- Hyper bilirubinemia Hydrocephalus.
Topographic classification: (distribution of motor defect)
1- Monoplegia → Only one limb is affected
2- Hemiplegia → Upper and lower limbs on one side are affected
3- Diplegia → All limbs are affected, the lower more affected than the upper limbs
4- Paraplagia → Only both lower limbs are affected
5- Quadriplegia → All the four limbs are affected
Clinical Types
- Spastic cerebral palsy
- Ataxic cerebral palsy
- Extrapyramidal (dyskinetic, asthetoid) cerebral palsy
- Atonic cerebral palsy
- Mixed cerebral palsy
Spastic cerebral palsy
Criteria
• The commonest type
• Pyramidal tract lesion (UMNL) signs: Hypertonia Hyper reflexia Positive Babinski sign May be clonus
• Persistence of primitive reflexes
• Pesudobulbar palsy p feeding disorder (poor suckling & swallowing),
🗣Hot potato speech
👀squint and speech disorders.
Spastic cerebral palsy types
- Spastic diplegia: 35%
- Spastic hemiplegia: 25%
- Spastic quadriplegia: 20%
- Spastic monoplegia
- Spastic paraplegia
Spastic diplegia: 35%
- Bilateral spasticity of the legs that is greater than in the arms
- More in premature with periventricular leucomalacia
- Crawling is commando like rather than four limbed crawling.
- Lower limbs scissoring (application of a diaper is difficult)
- With paraspinal muscle involvement, the child may be unable to sit.
- MRI typically shows scarring and shrinkage in the periventricular white matter with compensatory enlargement of the cerebral ventricles
Spastic hemiplegia: 25%
Due to in utero or neonatal stroke
- Decreased spontaneous movements on the affected side
- Shows hand preference at a very early age
- Walking is delayed until 18-24 mo (tiptoe walking); gait is circumdactive
- Examination of the extremities may show growth arrest, particularly in the hand and thumbnail
- Upper extremity assumes a flexed posture when the child runs
Spastic quadriplegia: 20%
- More ischemia and infection
- The most severe type
- Marked motor impairment of all extremities and the high association with mental retardation and seizures
Ataxic cerebral palsy
Criteria
- Hypotonia and hyporeflexia
* Cerebellar ataxiap incoordination of voluntary movements, nystagmus, staccato speech, intention tremors.
Extrapyramidal (dyskinetic, asthetoid) cerebral palsy
😟Commonest causes
• Asphyxia, kernictrus
😗Criteria
• Hypotonia (replaced with time with hypertonia & rigidity)
• Chorio asthetoid movements
. Deafness.
Atonic cerebral palsy
- Profound hypotonia p floppy infant
* Preserved deep tendon reflexes
Diagnosis/ clinical
A thorough history and physical examination should rule out a progressive disorder of the CNS, including degenerative diseases, metabolic disorders, spinal cord tumor, or muscular dystrophy
Diagnosis, investigation
Value: Exclude progressive brain insults and may detect a cause or association
a. CT & MRI
• May detect the cause e.g. brain malformations and spinal cord lesions
• Rule out brain tumors & degenerative brain disease.
• CT scan may be useful for detecting calcifications associated with congenital infections
b. TORCH screen.
c. Genetic evaluation
d. Metabolic screen.
e. For associations: Test for Hearing, Visual function , EEG for seizures
