Neuro - Cerebral Palsy

Question 1

Definition of cerebral palsy

Answer 1

-Permanent neurological problems that are not progressive

Question 2

Outline some antenatal, perinatal and postnatal causes of cerebral palsy

Answer 2

Antenatal (80%)

• Vascular occlusion, cortical migration disorders or structural maldevelopment of brain
• Maternal infection: rubella, CMV, toxoplasmosis

Perinatal

• Pre-term birth
• Hypoxic ischaemic encephalopathy

Post-natal

• meningitis/encephalitis/encephalopathy
• Kernicterus
• Head trauma

Question 3

What are the types of cerebral palsy?

Answer 3

• Spastic (90%)
• Dyskinetic (6%)
• Ataxic (4%)
• Mixed

Question 4

What is spastic (pyramidal) CP? Outline the type of symptoms and the types of regions affected

Answer 4

-Damage to motor cortex (UMN) t/f get hypertonia, brisk tendon reflexes and extensor palmar response

Regions affected:

• Monoplegia: 1 limb affected (Contralateral to lesion)
• Hemiplegia: 1 side affected
• Diplopia: 4 limbs affected but mostly legs
• Quadriplegia: 4 limbs severely affected, associated seizures, speech disturbances, poor head control and poor central tone

Question 5

What is dyskinetic CP? Name region of lesion, subtypes and associated condition

Answer 5

-Damage to basal ganglia (extrapyramidal) - causes increased muscle tone but intellect usually preserved

Types:

• Dystonic: alternates between rigidity and flaccid paralysis
• Choreoathetoid: involuntary movement leading to abnormal posture
• type of CP associated with hypoxic ischaemic encephalopathy

Question 6

What is ataxic CP? Where is the lesion and what type of signs do you get?

Answer 6

• Damage to cerebellum (extrapyramidal)
• Patients have problems with coordinated movement
• Signs occur on same side as lesion (which tends to be bilat) so you get asymmetrical signs

Question 7

What is mixed CP?

Answer 7

-Mix of spastic, dyskinetic and/or ataxic features

Question 8

Outline some signs and symptoms that should prompt suspicion of CP and referral for developmental assessment

Answer 8

• Failure to meet milestones
• Abnormal limb/trunk posture
• Hyper/hypo tonia
• Hand preference under 18 months
• Problems coordinating speech or walking
• Feeding/swallowing difficulties

Question 9

Describe a hemiplegic gait

Answer 9

• Increases muscle tone + spasticity in legs = extended legs and plantar flexion of feet and toes
• Must swing legs around in large semi-circle b/c not enough clearance below them

Question 10

Outline some complications of CP

Answer 10

• Learning difficulties
• Kyphoscoliosis
• Hearing/visual impairment
• Epilepsy
• Muscle contractures
• GORD

Question 11

How should a patient with CP be managed?

Answer 11

• Physio: contractures
• SLT
• OT
• Dietician
• Orthopaedics: tenotomy
• Paeds: muscle relaxants (baclofen), antiepileptics, glycopyrronium bromide (excessive drooling)