Neuro Condition

Question 1

definition of cerebral palsy

Answer 1

• Non-progressive brain lesion leading to disorder of movement and posture

Question 2

how common is cerebral palsy

Answer 2

2-2.5/100 in developed countries

Question 3

management of cerebral palsy

Answer 3

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

Question 4

what is the genetic makeup of Down’s syndrome

Answer 4

Trisomy 21 (47, XX/XY, +21)

Question 5

what are the different types of Down’s syndrome

Answer 5

chromosomal non-dysfuntional 95%

Robertsonian translocation 4%

mosaicism 1%

Question 6

what is the biggest RF for Down’s Syndrome

Answer 6

inc maternal age (2% at age 38)

Question 7

what is strabismus

Answer 7

squint which is all to do with lazy eye

Question 8

what are the 2 different types of strabismus

Answer 8

paralytic and non-paralytic

Question 9

When is the majority of the lesion occur?

Answer 9

Between conception and 3 yrs old

Question 10

What is the negotiate presentation of cerebral palsy

Answer 10

Hypotonia
Poor feeding
Fits

Question 11

When does spasticity develop in cerebral palsy

Answer 11

Later in the life of the children

Question 12

What are the in uterine causes of cerebral palsy

Answer 12

Congenital infection - TORCh syndrome

Question 13

What are the perinatal causes of cerebral palsy

Answer 13

Birth asphyxia
Prematurity
Kernicterus

Question 14

Causes of cerebral palsy after birth

Answer 14

Brian injury - can be traumatic
Meningitis
Encephalitis

Question 15

When is the most common time for cerebral palsy to develop

Answer 15

Antenatal

Question 16

What other conditions are associated with cerebral palsy?

Answer 16

•	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

Question 17

What is the aetiology of cerebral palsy

Answer 17

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

Question 18

What are the different types of cerebral palsy

Answer 18

Classified using movement impairment, anatomical distribution and functional level

Spastic

Dyskinaesia - dystonia, choreo-athetoid, athetosis

Ataxic

Question 19

What signify the features of spastic cerebral palsy

Answer 19

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

Question 20

What is equinvaous deformities

Answer 20

It is associated with spastic cerebral palsy consist of 3 components

Equines (plantar flexion)
Virus (towards midline)
Inversion of the foot

Question 21

Different types of dyskinaesia cerebral palsy

Answer 21

Dystonia - involuntary continuous movement resulting in twisting and abnor postures

Choreo-athetoid - rapid, involuntary, Jerry fragmented motion, hypotonia

Athetosis - slower, wresting or contorting movements

Question 22

What features signify ataxic cerebral palsy

Answer 22

Loss of muscular coordinations ain’t have abnor force and rhythm

Poor balance
Past pointing
Hypotonia

Question 23

What condition does scissoring gait feature in?

Answer 23

Spastic cerebral palsy

Question 24

What can cause dyskinaesic cerebral palsy

Answer 24

Hypoxic ischaemia injury

Kernicterus

Question 25

What are some UMN signs for spastic CP

Answer 25

Brisk reflexes
Conclusion
Clasp-knife hypertonia
Babinski response

Question 26

What is magic carpet sign and what does it signify?

Answer 26

It is when a baby is lifted, leg will lift to 90’ to trunk

Associated with unilateral spastic hemiplegia

Question 27

What investigation is done to diagnose cerebral palsy

Answer 27

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

Question 28

What are the functional classification for cerebral palsy?

Answer 28

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

Question 29

Management of CP

Answer 29

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