Week 222 Cerebral Palsy/autism Flashcards
Week 222
Where do the medullary pyramids decussate?
In the lower medulla.
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What do the Dorsal columns of the sensory spinal tracts transmit?
- Proprioception
- Fine touch
- Vibration
*Dorsal = back, decaussates at lower medulla*
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what do the Spinothalamic (sensory) tracts transmit?
Pain
Temperature
Crude touch (pressure)
*These are LATERAL structures, decussate where they enter the spinal cord*
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What is cerebral palsy?
A group of disorders of the development of movement and posture, causing activity limitation.
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What is cerebral palsy attributed to?
Non-progressive disturbances occuring in the foetal/infant brain.
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What is the most common classification of cerebral palsy?
Spastic cerebral palsy (80-90%)
Velocity associated resistance to passive stretch (fast is stiff, slow is not)
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What are the three main types of spastic cerebral palsy, and how do they differ?
- 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)
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Spastic Cerebral palsy is associates with damage to which part of the brain?
Cortex
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Extrapyrimadal cerebral is associated with damage to which region of the brain?
Extrapyrimidal system
(this means damage to basal ganglia and motor tracts - this affects modulation of anterior horn cells).
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What are the two common specific causes of cerebral palsy?
- Acute neonatal hyperbillirubinaemia
- Acute neonatal hypoxic ischaemic injury (hypoxia for a few minutes after birth)
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Dyskinetic Cerebal Palsy is charcterised by what type of muscle spasticity?
Fluctuating - not always hypertonic (as in spastic)
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What is seen in Dystonic Cerebral Palsy?
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
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What movements occur in Choreo-Athetoid cerebral palsy?
Athetoid is a slow, writhing movement (from distal to proximal)
Chorea- These are rapid involuntary movements
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Ataxic Cerebral Palsy is due to damage of which part of the brain?
Cerebellum
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Which milestones may a child miss, in cerebral palsy?
Sitting unsupported (6 MO)
Walking unsupported (1yr)
Hand preference shown before (1yr)
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What is Baclofen, and how does it work?
This is a GABAb antagonist (remember that GABA is an inhibitory neurotransmitter). This reduces spasticity with varying effect.
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Why is botulinum toxin used in the treatment of Cerebral Palsy? How does it work?
Botulinum blocks ACh release. This reduces tone for 3-4 months.
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What is the main surgical treatment for spastic cerebral palsy?
Selective Dorsal Rhizotomy
This eliminates spasticity, but leaves patient with very weak muscles.
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What are the functions of the cerebellum?
- Precision Co-ordination of movement
- Motor learning (learning motor response to conditioned stimulus)
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What are the 3 lobes of the cerebellum?
Anterior
Posterior
Flocculonodular
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What is the main blood supply to the superior cerebellar artery and anterior inferior cerebellar artery?
The basilar artery
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What supplies blood to the posterior inferior cerebellar artery?
Verterbral Artery
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What is ataxia?
Lack of gross motor co-ordination i.e. clumsiness
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What is dysarthria?
Poor articulation of speech due to motor problem.
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What is Dysdiadochokinesia?
This is an inability to perform rapid alternating movements.
Problems are ipsilateral to damaged side.
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When does crawling occur in normal gross motor development?
8-9 months.
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When does unsteady walking occur in normal gross motor development?
12 months
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When does swapping a toy from hand to the other occur in fine motor development?
6 months.
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When does scribbling with a pencil occur in fine motor development?
14 months
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When do you expect symbolic play to occur?
18 months old
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What is the GMFCS?
This is the gross motor function classification system.
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What is a GMFCS level 1?
Walks without limitations.
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What is GMFCS Level 2?
Walks with limitations
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What is GMFCS level 3?
Walks using a hand held mobility device.
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What is GMFCS level IV?
Self-mobility with limitations. May use powered mobility.
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What is GMFCS level V?
Transported in a manual wheelchair.
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The majority of hypoxic brain injuries leading to CP occur when?
The prenatal period (76-82%)
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Kernicterus and prenatal maternal iodine deficiency are known causes of which condition?
Cerebral Palsy
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What is periventricular leukomalacia?
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).
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What does this image show?
This is periventricular leukocytosis.
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What does this image show?
This shows serious decay of the white matter of the brain, specifically in the lateral ventricles. This is periventricular leukocytosis.
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what does APGAR stand for?
- Activity (Tone)
- Pulse
- Grimace (reflexes)
- Appearance
- Respiration
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What does this image show?
Kernicterus (Jaundiced brain!)
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The DSM 5 (pulblished in 2013) reorganised the triad of symptoms of autism spectrum disorder into a dyad. What are these two symptoms?
- difficulties in social communication and social interaction
- restricted and repetitive behaviour interests and activities
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what is echolalia?
This is the frequent repetition of set words.
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What type of drugs are risperidone and aripiprazole?
These are anti-psychotic medications.
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What is methylphenidate?
This is a stimulant, used in the treatment of ADHD related disorders in children with autism.
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What is the increase in mortality risk of patients with autism spectrum disorder?
2.8 x
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In which IQ range is a mild learning disability classified?
50/55-70
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In which IQ range is a moderate learning difficulty classified?
35/40-50/55
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In which IQ range is a severe learning disorder classified?
20/25-35/40
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In which IQ range will profound learning difficulty be diagnosed?
Below 20/25
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What are the Functions of the Cerebellum?
- 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
- Motor Learning - Learning of motor responses to a conditioned stimulus.
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The Superior cerebellar artery and the Anterior Inferior Cerebellar Artery arise from which artery?
The Basilar Artery.
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The Posterior Inferior Cerebellar Artery arises from which artery?
The Vertebral artery
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Which cells within the cerebellum (cortex) “Process” information?
Purkinje Cells
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Output information from the cerebellum passes throough which anatomical structure?
The Superior Peduncle
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What are the symptoms of damage to the cerebellum?
- Ataxia (gross loss of co-ordination)
- Dysarthria (poor speech articulation)
- Dysdiadocohokinesia (Ha! Try saying that ten times quickly!) - Inability to perform rapid alternating movements.
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Name as many differential causes of cerebral palsy as you can.
- Prenatal: Infection, toxins, drugs, trauma, >foetal movement
- Perinatal: Prematurity, Difficult birth, Abnormal tone, Post-birth pathology
- Delayed motor development
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What is Baclofen, and why is it used?
This is a GABAb antagonist - reduces spasticity with varying efficacy between individuals.
