Paediatrics: Birth defects/MSK Flashcards
What is cerebral palsy?
A group of permanent movement disorders that occurs as a result of damage to a child’s CNS involved in motor control, leading to impaired movement and coordination - the lesion that occurs is non-progressive i.e. it does not get worse but lifelong
What are the three types of causes of cerebral palsy?
1) Antenatal/intrapartum
2) Postnatal
3) Idiopathic
What are antenatal/intrapartum causes of cerebral palsy?
1) Hypoxic-ischaemic encephalopathy
2) Infection
What are postnatal causes of cerebral palsy?
1) Meningitis
2) Trauma
3) Haemorrhage
4) Medication toxicity
5) Kernicterus - never event as significant jaundice should be identified and treated asap
How does CP present?
1) Depends on the site and extent of the lesion
2) Widespread brain damage affecting multiple areas of motor control will result in a wide variety of motor impairments
What are the categories of motor disorders of cerebral palsy (not exclusive and can overlap)?
1) Spastic - 90% of patients with cerebral palsy have some spastic features
2) Dyskinetic/athetoid
3) Ataxic
What is spastic cerebral palsy caused by?
Damage to the pyramidal pathway (pyramidal weakness)
What are the features of spastic cerebral palsy?
1) Increased tone and reflexes
2) Clasp knife
3) Flexed hip and elbow
4) Scissor gait
5) May be monoplegic, diplegic, hemiplegic
What is dyskinetic/athetoid cerebral palsy caused by?
Damage to the basal ganglia pathways
How does dyskinetic/athetoid cerebral palsy present?
1) Choreiform movements
2) Can exhibit signs of Parkinsonism
What is ataxic cerebral palsy caused by?
Damage to the cerebellar pathways
How does ataxic cerebral palsy present?
1) Uncoordinated movements
2) Signs of cerebellar lesions
What are complications of cerebral palsy?
1) Injuries from impaired balance/coordination
2) Aspiration pneumonias from impaired swallowing
3) Muscle wasting
4) Scoliosis and other MSK deformities from impaired posture and muscle control
How is cerebral palsy managed?
1) Specialist and MDT input to minimise and deal with complications of cerebral palsy
2) Medical management
3) Surgical management
What type of specialist and MDT input is offered to minimise and deal with complications of cerebral palsy?
1) Physiotherapy - to help with movement and strength exercises
2) Occupational therapy - may help with mobility aids, home adjustments and devices e.g. orthotics
3) Speech and language therapy - for swallowing assessments
4) Dieticians - if there are concerns regarding low intake due to swallowing difficulties
What are medical management options for cerebral palsy?
1) Baclofen - for spasms
2) Botox injections - for contractures
What are surgical management options for cerebral palsy?
1) Orthopaedic surgery - for MSK deformities/injuries/tendon releases
2) General surgery - if a PEG tube needs fitting
What are the typical features of cerebral palsy presentation?
1) Delayed achievement of motor milestones
2) Hypertonia and brisk reflexes
What is a risk factor for hypoxic ischaemic encephalopathy?
Infants > 42 weeks who get stuck during prolonged labour e.g. emergency instrumental delivery after prolonged labour
How does Perthe’s disease present?
Limping child aged 4-10 years old
What is the genetic background of Becker’s muscular dystrophy?
X-linked recessive inherited disorder
How does Becker’s muscular dystrophy present?
1) Slowly progressive muscle weakness of the legs and pelvis
2) Regression of motor milestones e.g. walking
What type of jaundice is not severe enough to cause kernicterus?
Physiological breast milk jaundice (jaundice on day 2, peaks at day 7 then resolves)
Would congenital developmental dysplasia of the hip (CDH) prevent a child from learning to walk at an appropriate time?
No
