Cerebral Palsy and CNS Infections Flashcards
What is Cerebral Palsy (CP)?
CP is a general term describing a group of permanent disorders that appear in early childhood, primarily affecting motor abilities due to non-progressive brain damage.
When does CP typically develop?
CP can develop during fetal development, during birth, or in the first months of life, usually before 2-3 years of age.
What part of the brain is primarily affected in CP?
The higher motor centers are primarily affected, impacting motor control and coordination.
What other problems are commonly associated with CP?
CP is often associated with:
• Sensory and perceptual issues
• Learning disabilities
• Communication difficulties
• Behavioral challenges
• Epilepsy
• Orthopedic conditions
Is CP a progressive disorder?
No, CP is not progressive; however, its effects may change over time as the child grows and develops.
Can CP be cured?
CP cannot be cured, but early therapies can significantly improve physical and emotional adaptation.
Do most children with CP show problems during fetal development or at birth?
No, most children with CP do not show clinically apparent problems during fetal development or immediately after birth. Issues often become evident as motor skill development is observed.
How does CP develop?
CP develops when an infant’s brain is injured before, during birth, or in the early months of life while the brain is still forming.
What is the global prevalence of CP?
CP occurs in approximately 1 in 400 births worldwide.
What are the contributing factors that can lead to CP?
Several factors can interact to cause CP, including:
- Interrupted oxygen flow to the brain during a difficult birth or up to 3 years after birth due to trauma, poisoning, or near drowning.
- Abnormal brain development before birth, including brain malformations or biochemical disorders.
- Placental damage, impairing fetal nutrition and growth.
- Exposure to harmful substances, such as nicotine, alcohol, or drugs, during pregnancy.
- Infections, including German measles (rubella) in the mother, prolonged rupture of amniotic membranes leading to fetal infection, meningitis, or encephalitis.
- Low birth weight, often due to premature birth or multiple births.
- Brain hemorrhage, especially in very premature infants or from non-accidental trauma.
How can a difficult birth contribute to CP?
Abnormal positioning of the baby can cause interrupted oxygen flow to the brain, leading to CP.
How can infections lead to CP?
Infections like German measles (rubella) in the mother during pregnancy, prolonged amniotic membrane rupture, meningitis, or encephalitis can damage the developing brain and lead to CP.
Why are premature babies at higher risk for CP?
Premature babies have a higher risk of low birth weight, brain hemorrhage, and brain underdevelopment, all of which increase CP risk.
How can non-accidental trauma contribute to CP?
Shaken baby syndrome or other forms of abuse-related head trauma can cause brain hemorrhage, leading to CP.
How does the severity of Cerebral Palsy (CP) vary?
CP ranges from mild (e.g., slight weakness on one side) to severe (e.g., difficulty speaking or using arms/legs).
What motor issues are associated with CP?
CP can cause:
• Muscle tightness, stiffness, or spasms, especially with effort/activity
• Jerky, awkward, involuntary movement
• Unsteady gait and tremors
• Difficulty chewing and swallowing
• Restricted range of motion (ROM) due to muscle imbalances
What sensory, cognitive, and behavioral issues can occur in CP?
People with CP may experience:
• Hearing, visual, or speech impairments
• Problems with social skills and language development
• Learning and/or intellectual impairments
• Sensory and perception issues (e.g., difficulty judging distance)
• Seizures, epilepsy, or autism
• Behavioral disturbances
What are the three major types of CP?
The three major types are:
• Spastic CP (most common, 70-80%)
• Dyskinetic/Athetoid CP (10-20%)
• Ataxic CP (least common, 5-10%)
What are the characteristics of Spastic CP?
• Most common type (70-80% of cases)
• Involves muscle hypertonicity and spastic episodes
May affect:
• Both legs (Paraplegia)
• One side of the body (Hemiplegia)
• All four limbs + torso/face/mouth (Quadriplegia, usually due to hypoxia)
What are the characteristics of Dyskinetic (Athetoid) CP?
• Occurs in 10-20% of cases
• Causes involuntary movements in arms, hands, torso, and face (e.g., grimacing, tongue thrusting, squirming)
• Can interfere with speaking, feeding, swallowing, reaching, and grasping
• Symptoms worsen with emotional stress and effort
• Involuntary movements disappear during sleep
What are the characteristics of Ataxic CP?
• Least common (5-10% of cases)
• Caused by Cerebellar damage
Symptoms include:
• Shakiness and tremors
• Depth perception and coordination challenges
• Characteristic ataxic gait (wide and unsteady)
What is Mixed-Type CP?
A condition where a person has symptoms from more than one type of CP, most commonly spastic and dyskinetic.
How does physiotherapy help individuals with CP?
It helps maximize physical independence and mobility, often using orthotics, casts, and splints for support.
What is the role of occupational therapy in CP management?
It increases independence by teaching adaptive techniques and incorporating assistive equipment.
How does speech-language therapy help in CP?
It improves communication skills, including the use of alternative communication systems if necessary.
What medications are used to manage spasticity in CP?
Botox and Baclofen can help reduce spasticity.
What surgical interventions may help individuals with CP?
Orthopedic and soft tissue surgeries can counteract spasticity-related distortions in the spine, hips, and legs.
Is CP a progressive condition?
No, CP is not progressive, but its effects may worsen over time due to secondary complications.
What are potential long-term complications of CP?
• Congestive Heart Failure (CHF) → Reduces energy and activity levels
• Contractures and arthritis → Increase pain and reduce function
How does the level of assistance needed vary in CP?
• Severe cases may require wheelchairs and lifelong care
• Mild to moderate cases may require little or no special assistance
What are the four main types of CNS infections and the affected areas?
- Encephalitis – Affects brain tissue, typically caused by a virus (lymphocytic).
- Meningitis – Affects the meninges and cerebrospinal fluid (CSF), caused by a virus or bacteria (pyogenic).
- Transverse Myelitis – Affects the spinal cord, caused by bacteria, virus, fungus, parasite, or immune disorder.
- Cerebral Abscess – Pus enclosed in brain tissue, caused by bacteria, fungus, surgery, or trauma complications.
Why can CNS infections be misdiagnosed as the flu?
All CNS infections have flu-like onset symptoms, such as fever, fatigue, headache, digestive upset, muscle and joint pain, and anorexia, which can lead to misdiagnosis.
What are some neurological signs that indicate a CNS infection rather than just the flu?
• Photophobia (light sensitivity)
• Phonophobia (sound sensitivity)
• Altered vision, altered speech, disorientation
• Motor weakness, altered sensation, gait changes
• Altered consciousness, seizures, hallucinations
What are meningeal signs, and why are they important?
Meningeal signs indicate meninges inflammation and suggest meningitis, though they only present in a minority of patients.
What are the three main meningeal signs of meningitis?
- Severe neck pain and immobility (sudden and unexplained).
- Brudzinski’s Sign – Passive neck flexion in supine causes an involuntary flexion of the hips and knees due to upper meningeal traction.
- Kernig’s Sign – Passive hip flexion followed by passive knee extension in supine causes spinal pain or resistance if knee extension is <135° due to lower meningeal traction.
What other symptoms may be present in meningitis?
Skin rash and cranial nerve abnormalities.
What are the differences in onset between different types of CNS infections?
• Pyogenic (bacterial) and lymphocytic (viral) types – Sudden, acute onset.
• Granulomatous types – Often have a more gradual onset but can also be acute.
Who is most at risk for opportunistic granulomatous CNS infections?
• Young children
• Elderly individuals
• Immunocompromised individuals (e.g., cancer or AIDS patients)
• Seriously ill individuals
Give an example of an opportunistic CNS infection.
Candida encephalitis in terminally ill cancer or AIDS patients.
Which organism can cause severe CNS infection in a healthy adult?
Meningococcus has the capacity to make a healthy adult dangerously ill.
Which type of CNS infection has the best survival and recovery rate?
Lymphocytic infections generally have the best prognosis.
What are the survival rates for bacterial meningitis?
• Diagnosed early with treatment – 5% to 10% mortality, usually within 24-48 hours of symptom onset.
• Diagnosed late or untreated – Up to 50% mortality.
• Streptococcus pneumoniae meningitis – 17% mortality among hospitalized patients.
What are the survival rates for encephalitis?
• Hospitalized cases – 5% to 20% mortality, regardless of infection type.
• Diagnosed late or untreated – 50% to 75% mortality.
What is the median survival time for transverse myelitis?
8.9 years (some cases live up to 16 years).
What factors contribute to shorter survival times in transverse myelitis?
Older age and tobacco use.
What is the in-hospital mortality rate for cerebral abscess?
16% (commonly caused by Streptococcus bacteria).
Which type of CNS infection has the highest fatality rate? Why?
Granulomatous infections, because they commonly occur in immunocompromised individuals.
