Cerebral Palsy- Enrique Chaves Flashcards
define CP
a static (non-progressive) encephalopathy (brain injury) characterized by early onset of impaired movement and or posture
is CP useful as a medical term?
no not specific to cause or clinical manafestations, its a lay term only
etiology of prenatal cp (before birth)
intrauterine infection
chromosomal disorders
neurogenetic disorders
etiology of perinatal cp (at birth)
birth asphyxia (only 6%) -low APGAR scores -metabolic acidosis -neonat. seizure maternal bleeding Rh incompatibility (kernicterus)- yellow staining of the BG, billirubin too high and affects BG which is responsible for fluidity of movement
etiology of postnatal cp (after birth up to 2-3 years)
stoke
brain hemorrhage
infection or sepsis
classifications of CP:
topographical
hemiplegia (one side)
diplegia (both legs)= scissoring gait
quadriplegia (arms and legs)= seen in full term babies who suffer lack of o2
classifications of CP:
neurological
spastic (stiff)
athetoid (dyskinetic) worm like
ataxic (poor balance)
hypotonic
what do u have to be aware of with a hypotonic cp diagnosis?
that its a misdiagnosed mm or connective tissue disease, check with DTRs, if they are absent, its not brain related its mm related (SMA, etc.), but if it is a brisk reflex, its brain related (CP).
diff. between rigidity and spasticity
rigitidy= cogwheel spasticity= clasp knife
CP clinical manifestations that come late
primitive reflexes persist delayed milestones poor head growth delayed speech and language strabissmuss (lazy eye) very often associated with diplegia
whats a 4+ grade in reflexes?
clonus, multiple responses
whats a normal grade for reflexes?
2+
whats a 3+ grade for reflexes?
brisk, increased
levels of alertness in infant as part of neuro exam
alert and awake irritible- cortical irritibility sign of cp (hard to make happy) sonmolent- hard to arouse delirium stupor comatose
how to do head circumference
most prominent part of the forehead around the most prominent part of the occiput, measure 3 times, one right where u think, a lil above, a lil below and the biggest measurement wins
how do u know where or not to be concerned about head circumference?
if u’ve been measuring from birth and it starts dropping off or increaseing a lot and crossing norms
normal head circumference
2 SD
abnormally large
> 2 SD
microcephaly
3 SD below mean, 2 and a child can still be “normal”
+ babinski reflex is normal until when?
18 mo., after that it’s abnormal
lissencephaly
smooth brain
pachygyria
thick layer brain
when does neuronal migration occur
28 weeks
each neuron is guided by what to its final destination
glial cells
schizencephaly results in a child with what kind of cp?
hemiplegia (split brain)
heterotopia
misplaced brain
polymicrogyria
clusters of tiny gyri
signs of CP: birth to one month
weak/absent sucking and swallowing bradycardia/apnea high pitched cry jittery seizures abnormal primitive reflexes
signs of CP at 3 mo.
feeding probs tongue thrust irritability hypotonia/advanced head control in prone one or both hands fisted cortical thumb brisk DTRs (3+ or 4+) strabismus prim. reflexes persist
signs of cp at 6 mo.
delayed milestones handedness/fisting hypertonia difficult to dress little spontaneous mvmt arching, tendency to stand persistent reflexes
signs of CP at 9 mo
delated milestones abnormal or asymmetric crawl abnormal reaching tremors abnormal movements keeping arms flexed
signs of CP at 12 mo
scissoring
toe walking
athetoid movements
handedness
main indicator of birth asphyxia?
fetal HR
what is PVL?
Periventricular leucomalacia = injury to white matter around ventricles- caused by hopoxia/ischemia
all neurons start where?
germinal matrix zone
