cerebral_palsy_flashcards
How is Cerebral Palsy defined?
A disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain
What is the incidence of Cerebral Palsy in live births?
2 in 1,000 live births
What is the most common cause of major motor impairment?
Cerebral Palsy
List some antenatal causes of Cerebral Palsy.
Cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
List some intrapartum causes of Cerebral Palsy.
Birth asphyxia/trauma
List some postnatal causes of Cerebral Palsy.
Intraventricular haemorrhage, meningitis, head-trauma
What are some possible manifestations of Cerebral Palsy?
Abnormal tone in early infancy, delayed motor milestones, abnormal gait, feeding difficulties
What are some associated non-motor problems in children with Cerebral Palsy?
Learning difficulties, epilepsy, squints, hearing impairment
What percentage of children with Cerebral Palsy have learning difficulties?
60%
What percentage of children with Cerebral Palsy have epilepsy?
30%
What percentage of children with Cerebral Palsy have squints?
30%
What percentage of children with Cerebral Palsy have hearing impairment?
20%
What are the classifications of Cerebral Palsy?
Spastic, dyskinetic, ataxic, mixed
Describe spastic Cerebral Palsy.
70% of cases; increased tone resulting from damage to upper motor neurons; subtypes include hemiplegia, diplegia, or quadriplegia
Describe dyskinetic Cerebral Palsy.
Caused by damage to the basal ganglia and the substantia nigra; characterized by athetoid movements and oro-motor problems
Describe ataxic Cerebral Palsy.
Caused by damage to the cerebellum with typical cerebellar signs
What is the general approach to management for children with Cerebral Palsy?
A multidisciplinary approach is needed
What are some treatments for spasticity in Cerebral Palsy?
Oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery, selective dorsal rhizotomy
What other treatments may be required for children with Cerebral Palsy?
Anticonvulsants, analgesia as required
summarise cerebral palsy
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
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
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.
