Week 222 Cerebral Palsy/autism

Question 1

Week 222

Where do the medullary pyramids decussate?

Answer 1

In the lower medulla.

Question 2

Week 222

What do the Dorsal columns of the sensory spinal tracts transmit?

Answer 2

• Proprioception
• Fine touch
• Vibration

*Dorsal = back, decaussates at lower medulla*

Question 3

Week 222

what do the Spinothalamic (sensory) tracts transmit?

Answer 3

Pain

Temperature

Crude touch (pressure)

*These are LATERAL structures, decussate where they enter the spinal cord*

Question 4

Week 222

What is cerebral palsy?

Answer 4

A group of disorders of the development of movement and posture, causing activity limitation.

Question 5

Week 222

What is cerebral palsy attributed to?

Answer 5

Non-progressive disturbances occuring in the foetal/infant brain.

Question 6

Week 222

What is the most common classification of cerebral palsy?

Answer 6

Spastic cerebral palsy (80-90%)

Velocity associated resistance to passive stretch (fast is stiff, slow is not)

Question 7

Week 222

What are the three main types of spastic cerebral palsy, and how do they differ?

Answer 7

• Quadriplegic - all four limbs (10%)
• Diplegia (35%) affect both legs (more common than both arms)
• Hemiplegia (40%) Affects ONE SIE OF BODY (usually arm more than leg)

Question 8

Week 222

Spastic Cerebral palsy is associates with damage to which part of the brain?

Answer 8

Cortex

Question 9

Week 222

Extrapyrimadal cerebral is associated with damage to which region of the brain?

Answer 9

Extrapyrimidal system

(this means damage to basal ganglia and motor tracts - this affects modulation of anterior horn cells).

Question 10

Week 222

What are the two common specific causes of cerebral palsy?

Answer 10

• Acute neonatal hyperbillirubinaemia
• Acute neonatal hypoxic ischaemic injury (hypoxia for a few minutes after birth)

Question 12

Week 222

Dyskinetic Cerebal Palsy is charcterised by what type of muscle spasticity?

Answer 12

Fluctuating - not always hypertonic (as in spastic)

Question 13

Week 222

What is seen in Dystonic Cerebral Palsy?

Answer 13

Dystonia: Abnormal sustained contraction of both agonists and antagonists (muscle groups). the strongest muscles dictate the direction of flexion/extension.

This results in an abnormal posture.

You tend to see: Elbow and wrist FLEXION, and HIP EXTENSION/KNEE FLEXION

Question 14

Week 222

What movements occur in Choreo-Athetoid cerebral palsy?

Answer 14

Athetoid is a slow, writhing movement (from distal to proximal)

Chorea- These are rapid involuntary movements

Question 15

Week 222

Ataxic Cerebral Palsy is due to damage of which part of the brain?

Answer 15

Cerebellum

Question 16

Week 222

Which milestones may a child miss, in cerebral palsy?

Answer 16

Sitting unsupported (6 MO)

Walking unsupported (1yr)

Hand preference shown before (1yr)

Question 17

Week 222

What is Baclofen, and how does it work?

Answer 17

This is a GABAb antagonist (remember that GABA is an inhibitory neurotransmitter). This reduces spasticity with varying effect.

Question 18

Week 222

Why is botulinum toxin used in the treatment of Cerebral Palsy? How does it work?

Answer 18

Botulinum blocks ACh release. This reduces tone for 3-4 months.

Question 19

Week 222

What is the main surgical treatment for spastic cerebral palsy?

Answer 19

Selective Dorsal Rhizotomy

This eliminates spasticity, but leaves patient with very weak muscles.

Question 20

Week 222

What are the functions of the cerebellum?

Answer 20

• Precision Co-ordination of movement
• Motor learning (learning motor response to conditioned stimulus)

Question 21

Week 222

What are the 3 lobes of the cerebellum?

Answer 21

Anterior

Posterior

Flocculonodular

Question 22

Week 222

What is the main blood supply to the superior cerebellar artery and anterior inferior cerebellar artery?

Answer 22

The basilar artery

Question 23

Week 222

What supplies blood to the posterior inferior cerebellar artery?

Answer 23

Verterbral Artery

Question 24

Week 222

What is ataxia?

Answer 24

Lack of gross motor co-ordination i.e. clumsiness

Question 25

Week 222 What is dysarthria?

Answer 25

Poor articulation of speech due to motor problem.

Question 26

Week 222 What is Dysdiadochokinesia?

Answer 26

This is an inability to perform rapid alternating movements. Problems are ipsilateral to damaged side.

Question 27

Week 222 When does crawling occur in normal gross motor development?

Answer 27

8-9 months.

Question 28

## Footnote Week 222 When does unsteady walking occur in normal gross motor development?

Answer 28

12 months

Question 29

Week 222 When does swapping a toy from hand to the other occur in fine motor development?

Answer 29

6 months.

Question 30

Week 222 When does scribbling with a pencil occur in fine motor development?

Answer 30

14 months

Question 31

Week 222 When do you expect symbolic play to occur?

Answer 31

18 months old

Question 32

Week 222 What is the GMFCS?

Answer 32

This is the gross motor function classification system.

Question 33

Week 222 What is a GMFCS level 1?

Answer 33

Walks without limitations.

Question 34

Week 222 What is GMFCS Level 2?

Answer 34

Walks with limitations

Question 35

Week 222 What is GMFCS level 3?

Answer 35

Walks using a hand held mobility device.

Question 36

Week 222 What is GMFCS level IV?

Answer 36

Self-mobility with limitations. May use powered mobility.

Question 37

Week 222 What is GMFCS level V?

Answer 37

Transported in a manual wheelchair.

Question 38

Week 222 The majority of hypoxic brain injuries leading to CP occur when?

Answer 38

The prenatal period (76-82%)

Question 39

Week 222 Kernicterus and prenatal maternal iodine deficiency are known causes of which condition?

Answer 39

Cerebral Palsy

Question 40

Week 222 What is periventricular leukomalacia?

Answer 40

Periventricular leukomalacia, or PVL, is a type of **brain damage that involves the periventricular white matter of the brain**. Damage to the white matter results in the death and decay of injured cells, leaving empty areas in the brain — called lateral ventricles, which fill with fluid (a condition called leukomalacia).

Question 41

Week 222 What does this image show?

Answer 41

This is periventricular leukocytosis.

Question 42

Week 222 What does this image show?

Answer 42

This shows serious decay of the white matter of the brain, specifically in the lateral ventricles. This is **periventricular leukocytosis**.

Question 43

Week 222 what does APGAR stand for?

Answer 43

* Activity (Tone) * Pulse * Grimace (reflexes) * Appearance * Respiration

Question 44

Week 222 What does this image show?

Answer 44

Kernicterus (Jaundiced brain!)

Question 45

Week 222 The DSM 5 (pulblished in 2013) reorganised the triad of symptoms of **autism spectrum disorder** into a **dyad**. What are these two symptoms?

Answer 45

1. difficulties in social communication and social interaction 2. restricted and repetitive behaviour interests and activities

Question 46

Week 222 what is echolalia?

Answer 46

This is the frequent repetition of set words.

Question 47

Week 222 What type of drugs are risperidone and aripiprazole?

Answer 47

These are anti-psychotic medications.

Question 48

Week 222 What is methylphenidate?

Answer 48

This is a stimulant, used in the treatment of ADHD related disorders in children with autism.

Question 49

Week 222 What is the increase in mortality risk of patients with autism spectrum disorder?

Answer 49

2.8 x

Question 51

Week 222 In which IQ range is a mild learning disability classified?

Answer 51

50/55-70

Question 52

Week 222 In which IQ range is a moderate learning difficulty classified?

Answer 52

35/40-50/55

Question 53

Week 222 In which IQ range is a severe learning disorder classified?

Answer 53

20/25-35/40

Question 54

Week 222 In which IQ range will profound learning difficulty be diagnosed?

Answer 54

Below 20/25

Question 56

Week 222 What are the **Functions** of the **Cerebellum**?

Answer 56

1. Precision co-ordination of movement. Does **not** initiate motor signals etc, but does ensure **co-ordination**. *In injury or insult, px's have erratic, poorly timed movements* 2. **Motor Learning -** Learning of motor responses to a conditioned stimulus.

Question 57

week 222 The **Superior cerebellar artery** and the **Anterior Inferior Cerebellar Artery** arise from which artery?

Answer 57

The **Basilar Artery.**

Question 58

Week 222 The **Posterior Inferior Cerebellar Artery** arises from **which artery?**

Answer 58

The **Vertebral artery**

Question 59

Week 222 Which cells within the cerebellum (cortex) "Process" information?

Answer 59

Purkinje Cells

Question 60

Week 222 Output information from the cerebellum passes throough which anatomical structure?

Answer 60

The Superior Peduncle

Question 61

Week 222 What are the symptoms of damage to the cerebellum?

Answer 61

* **Ataxia** (gross loss of co-ordination) * **Dysarthria** (poor speech articulation) * **Dysdiadocohokinesia** (Ha! Try saying that ten times quickly!) - Inability to perform rapid alternating movements.

Question 62

Week 222 Name as many differential causes of cerebral palsy as you can.

Answer 62

* Prenatal: Infection, toxins, drugs, trauma, \>foetal movement * Perinatal: Prematurity, Difficult birth, Abnormal tone, Post-birth pathology * Delayed motor development

Question 63

Week 222 What is Baclofen, and why is it used?

Answer 63

This is a GABAb antagonist - reduces spasticity with varying efficacy between individuals.