Cerebral Palsy and Hypoxic-ischaemic Encephalopathy Flashcards
Define cerebral palsy.
Disorder of movement + posture due to non-progressive lesion of motor pathways in developing brain.
Define hypoxic-ischaemic encephalopathy (HIE).
Clinical manifestation of brain injury 48 h after hypoxic event.
Explain the aetiology of cerebral palsy.
Antenatal (80%): Cerebral malformation, congenital infections (rubella, toxoplasmosis, CMV).
Perinatal (10%): birth asphyxia/ trauma.
Postnatal (10%): Meningitis, IVH, head trauma
What are the risk factors for cerebral palsy?
Maternal infection
Preterm delivery
Low birthweight
What are the different types of cerebral palsy?
Spastic:
* Hemiplegia: damage to middle cerebral artery territory.
* Diplegia: IVH, ventricular dilation or periventricular lesion.
* Quadriplegia: widespread bilateral cerebral lesions.
Dyskinetic: Abnormality of extrapyramidal pathways (basal ganglia, thalamus).
Ataxic: Abnormal development of cerebellum.
Mixed
Explain the aetiology of hypoxic-ischaemic encephalopathy.
Obstructed labour: Malpresentation, cephalopelvic disproportion, multiple births (particularly 2nd twin due to prolapsed cord or malpresentation), postmature neonates.
Hypotension: Maternal haemorrhage (placental abruption, placenta praevia).
HTN: Fulminant pregnancy-induced HTN.
Infants at risk: Preterm infants, infants with CHD.
Which 7 other conditions can arise due to inadequate oxygenation and perfusion in hypoxic-ischaemic encephalopathy?
Persistent pulmonary HTN of the newborn
meconium aspiration syndrome
acute renal failure
NEC
hypoglycaemia
DIC
myocardial ischaemia
Occurs following perinatal events that reduce oxygen + glucose delivery to the brain. Exact pathology is unclear but involves excitatory neurotransmitters (glutamate, glycine), cell death by apoptosis, + an inflammatory reaction.
Summarise the epidemiology of cerebral palsy.
2/1000 live births.
Most common cause of motor impairment.
Clinical manifestations can emerge over time.
Summarise the epidemiology of hypoxic-ischaemic encephalopathy.
Moderate–severe HIE in 2–4/1000 live births.
What causes the increased tone in spastic cerebral palsy?
damage to upper motor neurons
What are 5 general presenting symptoms for cerebral palsy?
Delayed milestones
Poor feeding
Abnormalities of tone, posture, gait
Difficulties with language
Impaired social skills.
What are the presenting symptoms of spastic cerebral palsy?
Affected limbs show increased tone (clasp-knife), brisk reflexes, extensor plantar responses:
- Hemiplegia: unilateral, arm > leg, fisting + early hand preference <1y, characteristic posture of abduction of shoulder, flexion at elbow + wrist, pronation of forearm, + extension of fingers.
- Diplegia: legs > arms, hypertonicity of hip adductors! leg ‘scissoring’.
- Quadriplegia: all 4 limbs affected; arms > legs, poor head control, paucity of movement. Abnormal primitive reflexes + fisting in the first few months.
What are the presenting symptoms of dyskinetic cerebral palsy?
Normal progress until 6–9 months, followed by:
progressive dystonia of lower limbs, trunk, + mouth exaggerated by involuntary movements; athetoid (writhing) + choreographic (jerking).
What are 4 presenting symptoms of ataxic cerebral palsy?
Hypotonia
Ataxia of trunk + limbs
Postural imbalance
Intention tremor.
What are the presenting symptoms of hypoxic-ischaemic encephalopathy?
Poor APGAR score after 10 mins.
Neonatal resuscitation was required.
