Cerebral palsy & Encephalopathy Flashcards
What is cerebral palsy?
Permanent neurological problems resulting from damage to the brain around the time of birth
NON-PROGRESSIVE disease
What is hypoxic ischaemic encephalopathy?
Lack of oxygen to brain before or after birth
May lead to cerebral palsy
How to prevent severe brain damage in neonates with hypoxic injury?
Therapeutic cooling at 33-35 degrees attempts to reduce the chances of severe brain damage in neonates with hypoxic injury
How can the causes of cerebral palsy be categorised?
Antenatal 80%
Intrapartum 10%
Postnatal 10%
What are the antenatal causes of cerebral palsy?
Maternal infection = chorioamnionitis
Trauma during pregnancy
Intrapartum causes of cerebral palsy?
birth asphyxia / trauma
pre-term birth
What are postnatal causes of cerebral palsy?
intraventricular haemorrhage
(periventricular leukomalacia - bilateral multiple cysts causing 80-90% of spastic CP)
head trauma
How to classify the types of cerebral palsy?
Spastic 70%
Dyskinetic
Ataxic
Mixed
What are the features of spastic cerebral palsy?
Hypertonia and reduced function resulting from damage to upper motor neurones = motor cortex
What are the subtypes of spastic cerebral palsy?
Monoplegia = 1 limb affected
Hemiplegia = 1 side of body affected
Diplegia = all 4 limbs, mainly legs
What are the features of dyskinetic cerebral palsy?
Problems controlling muscle tone with hyper and hypotonia
athetoid movements and oromotor problems
Due to damage to BASAL GANGLIA
Dyskinetic cerebral palsy can have 3 types of movements which are?
Athetoid movements : slow writing movements of hands + feet + difficulty holding objects
Oro-motor problems : drooling
Chorea : uncontrolled repetitive movements
What features are seen in ataxic cerebral palsy?
Problems with COORDINATION because of damage to the CEREBELLUM
balancing wen walking or grabbing stuff is hard
Clinical symptoms of cerebral palsy?
Failure to meet milestones
Hand preference before 12 months
Feeding / swallowing issues
Abnormal gait, speech, coordination
Toe walking
What are the NICE guidelines for urgent referral regarding motor milestones? (3)
Not sitting by 8 months
Not walking by 18 months
hand preference before 1 year
What is the gold standard investigation for diagnosis of cerebral palsy?
MRI Head
- difficult irl as children need sedative to stay still during MRI
If a child has risk factors for CP?
Offer MDT follow up for 2 years
How to manage a child with CP?
MDT: paeds, physio, speech and language for eating and swallowing
How to manage muscle stiffness symptomatic treatment?
Baclofen
How to manage sleep symptomatic treatment?
melatonin
How to manage constipation symptomatic treatment?
laxatives
How to manage drooling symptomatic treatment?
anticholinergics (glycopyrronium bromide).
Complications of cerebral palsy?
Learning disability
epilepsy
kyphoscoliosis
muscle contractures
GORD
