Neuro Condition Flashcards
definition of cerebral palsy
• Non-progressive brain lesion leading to disorder of movement and posture
how common is cerebral palsy
2-2.5/100 in developed countries
management of cerebral palsy
improve functional abilities and QoL
MDT - physiotherapy
OT - wheelchairs
SALT - feeding, swelling problems
medication - anticonvulsants for epilepsy, baclofen for spasm
botox injections into spastic muscles
surgical –> dislocation repair, tendon lengthening, osteotomy
what is the genetic makeup of Down’s syndrome
Trisomy 21 (47, XX/XY, +21)
what are the different types of Down’s syndrome
chromosomal non-dysfuntional 95%
Robertsonian translocation 4%
mosaicism 1%
what is the biggest RF for Down’s Syndrome
inc maternal age (2% at age 38)
what is strabismus
squint which is all to do with lazy eye
what are the 2 different types of strabismus
paralytic and non-paralytic
When is the majority of the lesion occur?
Between conception and 3 yrs old
What is the negotiate presentation of cerebral palsy
Hypotonia
Poor feeding
Fits
When does spasticity develop in cerebral palsy
Later in the life of the children
What are the in uterine causes of cerebral palsy
Congenital infection - TORCh syndrome
What are the perinatal causes of cerebral palsy
Birth asphyxia
Prematurity
Kernicterus
Causes of cerebral palsy after birth
Brian injury - can be traumatic
Meningitis
Encephalitis
When is the most common time for cerebral palsy to develop
Antenatal
What other conditions are associated with cerebral palsy?
• Head o Learning difficulties – 60% o Epilepsy, seizures – 40% o Squint – 30% o Visual impairment – 20% o Hearing impairment – 20% • Speech and swallowing o Swallowing problems —> PEG tube for feeding o Speech and language disorders • Behavioural disorders • Joint disorders —> Contractures, Subluxation, Scoliosis
What is the aetiology of cerebral palsy
It depends on the mechanism of the injuries of brain lesion but they all seems to lead to periventricular leukomalacia which means white matter damages involving the internal capsule
There can be damages to the basal ganglia
There can be damages to the cerebellum
What are the different types of cerebral palsy
Classified using movement impairment, anatomical distribution and functional level
Spastic
Dyskinaesia - dystonia, choreo-athetoid, athetosis
Ataxic
What signify the features of spastic cerebral palsy
Hip addiction
Flexed knee (scissoring git)
Ankle plantar flexion (equinox’s arums)
Upper extremities can be - wrist flexion, elbow flexion and thumb-in-palm deformities
What is equinvaous deformities
It is associated with spastic cerebral palsy consist of 3 components
Equines (plantar flexion)
Virus (towards midline)
Inversion of the foot
Different types of dyskinaesia cerebral palsy
Dystonia - involuntary continuous movement resulting in twisting and abnor postures
Choreo-athetoid - rapid, involuntary, Jerry fragmented motion, hypotonia
Athetosis - slower, wresting or contorting movements
What features signify ataxic cerebral palsy
Loss of muscular coordinations ain’t have abnor force and rhythm
Poor balance
Past pointing
Hypotonia
What condition does scissoring gait feature in?
Spastic cerebral palsy
What can cause dyskinaesic cerebral palsy
Hypoxic ischaemia injury
Kernicterus
What are some UMN signs for spastic CP
Brisk reflexes
Conclusion
Clasp-knife hypertonia
Babinski response
What is magic carpet sign and what does it signify?
It is when a baby is lifted, leg will lift to 90’ to trunk
Associated with unilateral spastic hemiplegia
What investigation is done to diagnose cerebral palsy
Usually clinical diagnosis but imaging helps to locate the lesion and give more accurate sub-typing
1st line - MRI brain - periventricular leukomalacia, signs of previous intraventroicular haemorrhage
CT - to find any cerebral malformation
Hearing/vision test
SALT - to assess swallowing to make sure safe to feed or surgical insertion of. PEG tube
Genetic testing - chromosomes, fragile X
What are the functional classification for cerebral palsy?
Level 1 - walks without restrictions
Level 2 - limitations walking outdoors
Level 3 - walks with aids inside
4 - limited self-morbidity inside
5 - self mobility severely limited
Management of CP
Improve QoL
Physio to strengthen muscles, better ability to walk
OT - wheelchairs etc
SALT - swallowing difficulties and dspeech problems
Medication
- all - can have clonazepam to reduce tremors and improve sleep quality, anti-epileptics to control seizures
- spastic - baclofen, Botox to reduce spasm
- dyskinesia- carbidopa/levodopa, Botox to reduce spasm
Surgery - to fix equinvarous, talipes, repair any dislocation, lengthening the tendons
