cerebral_palsy_flashcards

Question 1

How is Cerebral Palsy defined?

Answer 1

A disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain

Question 2

What is the incidence of Cerebral Palsy in live births?

Answer 2

2 in 1,000 live births

Question 3

What is the most common cause of major motor impairment?

Answer 3

Cerebral Palsy

Question 4

List some antenatal causes of Cerebral Palsy.

Answer 4

Cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)

Question 5

List some intrapartum causes of Cerebral Palsy.

Answer 5

Birth asphyxia/trauma

Question 6

List some postnatal causes of Cerebral Palsy.

Answer 6

Intraventricular haemorrhage, meningitis, head-trauma

Question 7

What are some possible manifestations of Cerebral Palsy?

Answer 7

Abnormal tone in early infancy, delayed motor milestones, abnormal gait, feeding difficulties

Question 8

What are some associated non-motor problems in children with Cerebral Palsy?

Answer 8

Learning difficulties, epilepsy, squints, hearing impairment

Question 9

What percentage of children with Cerebral Palsy have learning difficulties?

Answer 9

60%

Question 10

What percentage of children with Cerebral Palsy have epilepsy?

Answer 10

30%

Question 11

What percentage of children with Cerebral Palsy have squints?

Answer 11

30%

Question 12

What percentage of children with Cerebral Palsy have hearing impairment?

Answer 12

20%

Question 13

What are the classifications of Cerebral Palsy?

Answer 13

Spastic, dyskinetic, ataxic, mixed

Question 14

Describe spastic Cerebral Palsy.

Answer 14

70% of cases; increased tone resulting from damage to upper motor neurons; subtypes include hemiplegia, diplegia, or quadriplegia

Question 15

Describe dyskinetic Cerebral Palsy.

Answer 15

Caused by damage to the basal ganglia and the substantia nigra; characterized by athetoid movements and oro-motor problems

Question 16

Describe ataxic Cerebral Palsy.

Answer 16

Caused by damage to the cerebellum with typical cerebellar signs

Question 17

What is the general approach to management for children with Cerebral Palsy?

Answer 17

A multidisciplinary approach is needed

Question 18

What are some treatments for spasticity in Cerebral Palsy?

Answer 18

Oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery, selective dorsal rhizotomy

Question 19

What other treatments may be required for children with Cerebral Palsy?

Answer 19

Anticonvulsants, analgesia as required

Question 20

summarise cerebral palsy

Answer 20

Cerebral palsy

Cerebral palsy may be defined as a disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain. It affects 2 in 1,000 live births and is the most common cause of major motor impairment.

Causes
antenatal (80%): e.g. cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
intrapartum (10%): birth asphyxia/trauma
postnatal (10%): intraventricular haemorrhage, meningitis, head-trauma

Possible manifestations include:
abnormal tone early infancy
delayed motor milestones
abnormal gait
feeding difficulties.

Children with cerebral palsy often have associated non-motor problems such as:
learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairment (20%)

Classification
spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons
dyskinetic
caused by damage to the basal ganglia and the substantia nigra
athetoid movements and oro-motor problems
ataxic
caused by damage to the cerebellum with typical cerebellar signs
mixed

Management
as with any child with a chronic condition a multidisciplinary approach is needed
treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy
anticonvulsants, analgesia as required

Question 21

A 12-month-old child is brought to the paediatric clinic following a referral from their GP. The parents report that the child demonstrates slow, twisting movements of the hands and arms, with varying intensity that tends to increase during periods of excitement. They also observe difficulties with oral manipulation of food, as well as challenges in chewing and swallowing solid foods. The child was born at 36 weeks gestation after a prolonged and difficult labour involving multiple attempts at forceps delivery.

What area of the brain is most likely affected?

Amygdala
Basal ganglia and the substantia nigra
Cerebellum
Medial thalamus and mammillary bodies of the hypothalamus
Primary motor cortex

Answer 21

Basal ganglia and the substantia nigra

Dyskinetic cerebral palsy typically manifests as athetoid movements and oro-motor problems

The correct answer is basal ganglia and the substantia nigra. The child in question exhibits typical manifestations of dyskinetic cerebral palsy, which is the second most prevalent subtype of cerebral palsy. Classical symptoms encompass athetoid movements and oro-motor difficulties. These issues commonly arise from cerebral malformations that occur during development or from complications at birth that lead to hypoxia. Such events specifically injure the basal ganglia and the substantia nigra, regions instrumental in regulating voluntary movement.

Athetoid disturbances are characterized by slow, involuntary, writhing motions affecting the limbs, face, neck, tongue, and various muscle groups. These may be accompanied by dystonia and choreoathetosis. Consequently, these disturbances manifest as oro-motor challenges; in this case, difficulty manipulating food within the mouth and struggles with masticating and swallowing solid foods confirm this diagnosis.

Lesions to the amygdala, part of the limbic system, usually result in a distinct pattern known as Kluver-Bucy syndrome. This syndrome is typified by hypersexuality, hyperorality, hyperphagia, and visual agnosia—none of which are observed in this patient—thus excluding this diagnosis.

Cerebellar damage incurred during gestation or delivery can lead to ataxic cerebral palsy. Clinical signs would include dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, and hypotonia. An intention tremor is often a prominent symptom that intensifies with sustained movement resulting in hand tremors. However, given that this patient demonstrates athetoid movements and oro-motor issues rather than cerebellar signs, this option is not applicable.

Damage to the medial thalamus and mammillary bodies of the hypothalamus is associated with Wernicke-Korsakoff syndrome. This condition is typically seen in individuals with chronic alcoholism or severe nutritional deficiencies. It presents with nystagmus, ophthalmoplegia, and ataxia followed by amnesia at later stages—symptoms not present in this patient—thereby ruling out this diagnosis.

Lastly, injury to the primary motor cortex leads to spastic cerebral palsy—the most common form of cerebral palsy—which features increased muscle tone due to upper motor neuron damage. Spastic cerebral palsy can be further categorised based on the limbs affected into hemiplegic, diplegic or quadriplegic subtypes. As there are no indications of spasticity in this patient’s presentation; therefore this option is also incorrect.