Cerebral palsy and hypoxic-ischaemic encephalopathy Flashcards
Cerebral palsy can be defined as a movement disorder, where damage to the brain causes a palsy of some kind. What is the incidence of this?
1 - 200-350 per 1,000 live births
2 - 20-35 per 1,000 live births.
3 - 2-3.5 per 1,000 live births.
4 - 0.2-0.35 per 1,000 live births.
3 - 2-3.5 per 1,000 live births
Most common cause of motor impairment
This is in resource rich countries, likely to be higher in poorer countries due safe antenatal and perinatal care, and poorer nutrition
Do the majority of cerebral palsies occur before or after birth?
- before birth
Categorised as a neurodevelopment condition, where part of the cerebrum does not develop correctly
All of the following are causes of prenatal (before birth) cerebral palsy, EXCEPT which one?
1 - infection
2 - head trauma
3 - hypoxia of babies brain
4 - radiation exposure
2 - head trauma
Not common pre-natally, but can occur postnatally.
All of the following are causes of postnatal (before birth) cerebral palsy, EXCEPT which one?
1 - infection
2 - head trauma
3 - hypoxia of babies brain
4 - radiation exposure
4 - radiation exposure
Not common
Typically occurs prenatally
Are there genetic causes of cerebral palsy?
- yes
Is cerebral palsy considered as a progressive condition?
- no
Patients typically do NOT deteriorate
Do patients with cerebral palsy typically have hypo or hypertonia?
- hypertonia
Often described as stiff or spastic, making movements appear jerky
There are different classifications of cerebral palsy based on the type of muscle movement that result from the damage to the brain. Which of the following accounts for 70% of cerebral palsy cases?
1 - spastic
2 - dyskinetic
3 - ataxic
4 - mixed
1 - spastic
Can be:
- hemiplegic = one side of the body
- diplegic = both legs
- quadriplegic = all limbs
In spastic cerebral palsy, where is the lesion in the brain most likely to be?
1 - somatosensory cortex
2 - motor cortex
3 - broca cortex
4 - posterior parietal cortex
2 - motor cortex
In spastic cerebral palsy, the lesion in the brain is most likely to be in the motor cortex. Which neurotransmitter are the neurons in the lesion less sensitive to, that results in over excitatory and hypertonia?
1 - serotonin
2 - dopamine
3 - glutamate
4 - GABA
4 - GABA
Inhibitory neurotransmitter
Less inhibition means more excitation
Another form of cerebral palsy is dyskinetic/abnormal movement. Which part of the brain is the lesion most likely to have occurred in?
1 - somatosensory cortex
2 - motor cortex
3 - basal ganglia
4 - posterior parietal cortex
3 - basal ganglia
Important for initiating and stopping unwanted movements
If basal ganglia doesn’t work properly, patients can have unwanted movements
Which 2 of the following can be caused by dyskinetic cerebral palsy, which is due to a lesion in the basal ganglia?
1 - chorea
2 - myoclonus
3 - fasciculations
4 - dystonia
1 - chorea
- random “dance-like” movements, since the small uncontrolled movements seem to move from muscle to muscle
4 - dystonia
- random, slow, and uncontrolled movements in the limbs and trunk
Another form of cerebral palsy is ataxia movement. Which part of the brain is the lesion most likely to have occurred in?
1 - cerebellum
2 - motor cortex
3 - basal ganglia
4 - posterior parietal cortex
1 - cerebellum
Causes shaky or uncoordinated movements
All of the following are features of ataxia cerebral palsy, EXCEPT which one?
1 - clumsy
2 - unstable movements
3 - random, slow, and uncontrolled movements in the limbs and trunk
4 - poor balance
3 - random, slow, and uncontrolled movements in the limbs and trunk
Although all patients are unique, most children with cerebral palsy often have associated non-motor problems. Which of the following is most common?
1 - learning difficulties
2 - epilepsy
3 - squints
4 - hearing impairment
1 - learning difficulties
Although all patients with cerebral palsy are unique, which of the following is NOT a common presentation of patients with cerebral palsy?
1 - abnormal tone (especially in infancy)
2 - delayed motor milestones
3 - abnormal gait
4 - feeding difficulty
5 - breathing difficulty
6 - pain in muscles/joints
7 - sleep disorders
5 - breathing difficulty
Abnormal gait
- some muscles stiffer than others
- often a scissor gate, due to over-excitation of adductor muscles
- toe walk can occur due to calf over activation
All of the following can be used to diagnose cerebral palsy, but which is most common method?
1 - MRI (head and spine)
2 - clinical diagnosis
3 - biochemical workup
4 - genetic testing
2 - clinical diagnosis
Other approaches typically rule out other causes
All of the following can be used alongside physical therapy to help treat the symptoms of cerebral palsy, EXCEPT which one?
1 - botulinum toxin type A injections
2 - diazepam
3 - rocuronium
4 - baclofen
3 - rocuronium
- non-depolarising neuromuscular blocker used in Anaesthesia
Baclofen = GABAb receptor agonist
Botulinum = blocks presynaptic release of acetylcholine
Diazepam = GABAa receptor agonist
Is surgery offered in cerebral palsy?
- yes
- loosening tight muscles
- straighten bones that have been subject to abnormal muscle forces over time
- cutting certain nerves to reduce their associated movements or spasms
Hypoxic (oxygen)-ischaemic (blood) encephalopathy is a term used to describe a lack of blood and oxygen to the brain during childbirth. How common is this?
1 - 0.3 per 1000 live births
2 - 3 per 1000 live births
3 - 30 per 1000 live births
4 - 300 per 1000 live births
2 - 3 per 1000 live births
Relatively rare in modern countries, likely to be higher in poorer countries
Hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) is a term used to describe a lack of blood and oxygen to the brain during childbirth. How quickly can cells in the babies brain die due to HIE?
1 - seconds
2 - minutes
3 - hours
4 - days
2 - minutes
HIE can cause neurological or developmental problems
Although the exact cause of hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) is unknown, which of the following are risk factors?
1 - low or high maternal BP
2 - Heart problems/stroke in the baby
3 - Uterus/placenta problems
4 - delayed labour
5 - emergency C-section
6 - reduced blood flow in pregnancy
7 - maternal trauma
8 - all of the above
8 - all of the above
Babies affected by hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) can present with all of the following, EXCEPT which one?
1 - unusual state of being awake and aware, such as highly alert or very low energy
2 - breathing difficulty
3 - projectile vomiting
4 - trouble hearing
5 - seizures/neurological issues
6 - muscle or reflex problems
7 - bradycardia
8 - organ failure
3 - projectile vomiting
Can have difficulty eating though
