Palsie

Question 1

What are Cerebral palsies

Answer 1

Most common motor disability in children

group of disorders affecting
muscle tone
Posture
development of movement

D/2 non-progressive damage to the brain in utero or up to the age of 3 year

Depending on the affected brain area, spastic, ataxic, or dyskinetic cerebral palsy develops

Question 2

What causes cerebral palsy

Answer 2

Idiopathic (most cases)

Risk factors:
Preterm birth and low birth weight (most important risk factors)

TORCH infection

Perinatal asphyxia
Intracranial hemorrhage 
Structural abnormality of the brain
Neonatal seizures
Kernicterus
Postnatal infection (e.g., meningitis, encephalitis)

Question 3

What are the most common risk factors for cerebral palsy

Answer 3

Preterm birth and low birth weight

Question 4

What are congenital TORCH infections

Answer 4

Acronym of congenital pathogens transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum)

T for toxoplasmosis
O for others (including syphilis, varicella-zoster virus, parvovirus B19, possibly listeriosis)
R for rubella
C for cytomegalovirus (CMV)
H for herpes simplex virus (HSV)/HIV/HEPATITIS

Question 5

Classification of cerebral palsies(2)

Answer 5

Spastic cerebral palsy: (75% of cases)
spastic paresis of one or more limbs

Non-spastic cerebral palsy :(2 types)

• Dyskinetic: abnormal involuntary movements (choreoathetoid, dystonic)
• Ataxic: intention tremor, lack of balance and coordination

Question 6

General sx of cerebral palsy

Answer 6

Patients do not reach certain milestones

• can’t roll over from back to tummy(lmao like insects )
• can’t sit independent,y
• can’t crawl

Intellectual disability (50%) 
- most common in spastic type 

Seizure disorder (35%–50%)

Joint contracture

ADHD

Question 7

Sx in spastic type of cerebral palsy

Answer 7

Hypertonia of one or more limbs however infants initially have HYPOTONIA then develop spasticity after 6-12 months as brain matured

↑ Deep tendon reflexes

Persistence of primitive reflexes (positive Babinski sign)

Toe walking
Pes Equinus deformity( flexion deformity of the foot)

Muscle weakness and/or atrophy

Scissor gait (d/2 spastic paraplegia of the hip adductors)

Hip dislocation

Scoliosis

Hearing or vision impairment

Question 8

DTR TEST

Answer 8

reflex to test the integrity of a sensory and motor neuron circuit.

tapping of the reflex hammer causes activation of the dorsal root ganglion

causes firing of the lower motor neuron for the agonist muscle and relaxation of the antagonist muscle,

resulting in automatic movement.

increased DTR indicates an upper motor neuron issue

decreased DTR indicates a LMN, neuromuscular junction, or muscle issue.

Question 9

Sx of non spastic type of cerebral palsy

Answer 9

Abnormal involuntary movements that worsen with stress and disappear with sleep

Specific sx are

Chorea: continuous, involuntary, rapid, abrupt, irregular, and not driven by urge- or compulsion
-involve the shoulders, hips, and face.

Athetosis: involuntary writhing movements of the fingers, hand, toes, and/or extremities caused by damage to the thalamus, striatum of the basal ganglia

choreoathetosis: athetosis and choreiform combo

Dystonia: muscle contrxn causing FIXED POSTURE and a normal movements
-forceful cntrxn of jaw

Ataxia: lack of coordination of voluntary movements. 2 mech / causes

1. impaired cerebellar function (cerebellar ataxia)
2. impaired vestibular function (vestibular)
3. Loss of proprioceptive sensation (sensory ataxia).

Dysarthria: difficulty w/ articulation

dysphagia: difficulty eating
- caused by pseudobulbar involvement

Question 10

How is the dg of cerebral palsy done

Answer 10

mainly based on the clinical picture.

Imaging

Cranial ultrasonography in early neonatal period to screen for risk factors

• intracerebral hemorrhage
• hypoxic-ischemic injury
• structural abnormalities

MRI (in older infants): to detect causative lesion
-periventricular leukomalacia(injury of cerebral white matter (necrosis ) d/2 ischemia /infection)

• congenital malformation
• intracranial hemorrhage

Question 11

How is CP rx

Answer 11

No definitive rx

All therapy is aimed to manage sx and Improve QOL

Antispasmodics

• botulinum toxin,
• baclofen: GABA agonist muscle relaxant
• dantrolene: inhibit r in sarcoplasmic reticulum’ less calcium released’ less spasm
• benzodiazepines

Physical therapy

Surgery

• treat scoliosis
• relieve joint contractures)

Bracing to prevent contractures

Speech therapy for dysarthria

Nutritional support for dysphagia

Special tuition for intellectual disability

Social and psychological support