Neurology

Question 1

Cerebral palsy

Answer 1

Range of nonhereditary, nonprogressive disorders of movement and posture. It is the most common movement disorder in children.

Often results from perinatal neurologic insult, but in most cases the cause is unknown

Risk includes:

1) Low birth weight
2) Intrauterine exposure to maternal infection
3) Prematurity
4) Perinatal asphyxia
5) Trauma
6) Brain malformation
7) neonatal cerebral hemorrhage

Question 2

Pyramidal (spastic) CP

Answer 2

Spastic paresis of any or all limbs.

Accounts for 75% of cases. Mental retardation is present in up to 90% of cases

Question 3

Extrapyramidal (Dyskinetic) CP

Answer 3

Result of damage to extrapyramidal tracts.

Subtypes are ataxic (trouble coordinating purposeful movements), choreoathetoid, and dystonic (uncontrollable jerking, writhing or posturing). Abnormal movements worsen with stress and disappear during sleep

Question 4

Most common presenting symptom of CP

Answer 4

Delayed motor development

Question 5

History and exam in CP

Answer 5

1) May be associated with seizure disorders, behavioral disorders, hearing or vision impairment, learning disabilities, and speech defects
2) Affected limbs may show hyperreflexia, pathologic reflexes (Babinski), increased tone/contractures, weakness, and/or underdevelopment
3) Toe walking and scissor gait are common. Hip dislocations and scoliosis may be seen

Question 6

Dx of CP

Answer 6

Diagnosed by clinical impression. US may be useful in infants to identify intracranial hemorrhage or structural malformations. MRI is diagnostic in older children. EEG may be useful in patients with seizures.

Question 7

Tx of CP

Answer 7

1) No cure. Special education, PT, braces, and surgical release of contractures may help
2) Treat spasticity with diazepam, dantrolene or baclofen. Baclofen pumps and posterior rhizotomy may alleviate severe contractures