Cerebral Palsy - doc meg`s hideout

Dr. Meg-angela Christi Amores
Cerebral Palsy (CP)
diagnostic term used to describe a group of motor
resulting from disorders of early brain development
often associated with epilepsy and abnormalities of
speech, vision, and intellect
selective vulnerability of the brain's motor systems
Epidemiology and Etiology
the most common and costly form of chronic motor
disability that begins in childhood
prevalence of 2/1000
80% of cases – antenatal factors causing abnormal
brain development
<10% - had evidence of intrapartum asphyxia
High prevalence in low birth weight infants due to
intracerebral hemorrhage
congenital anomalies external to the central nervous
Intrauterine exposure to maternal infection (e.g.,
chorioamnionitis, inflammation of placental
membranes, umbilical cord inflammation, foulsmelling amniotic fluid, maternal sepsis, temperature
greater than 38°C during labor, and urinary tract
Periventricular leukomalacia
Clinical manifestations - syndromes
Spastic hemiplegia
 arm
is often more involved than the leg
 difficulty in hand manipulation is obvious by 1 yr old
 Walking delayed until 18-24 mo
 growth arrest, particularly in the hand and thumbnail
 1/3 have seizure disorder
 25% have cognitive abnormalities including mental
 MRI : Focal cerebral infarction
Clinical manifestations - syndromes
Spastic diplegia
 bilateral
spasticity of the legs greater than in the arms
 often noted when an affected infant begins to crawl
 tends to drag the legs behind as a rudder (commando
 scissoring posture of the lower extremities
 Walking is significantly delayed
 Excellent prognosis for normal cognition
 Minimal seizures
 MRI: periventricular leukomalacia
Clinical manifestations – syndromes
Spastic quadriplegia
 Most
severe form
 marked motor impairment of all extremities
 high association with mental retardation and seizures
 speech and visual abnormalities
 MRI: severe PVL and multicystic cortical
Clinical manifestations – syndromes
Athetoid CP
 also
called choreoathetoid or extrapyramidal CP
 characteristically hypotonic with poor head control and
marked head lag
 Feeding may be difficult, and tongue thrust and
 Speech is typically affected
thorough history and physical examination should
preclude a progressive disorder of the CNS
MRI scan of the brain is generally indicated to
determine the location and extent of structural
tests of hearing and visual function
team of physicians from various specialties, as well
as occupational and physical therapists, speech
pathologists, social workers, educators, and
developmental psychologists
no proof that physical or occupational therapy
prevents development of CP
evidence shows that therapy optimizes the
development of an abnormal child
spastic diplegia
 assistance
of adaptive equipment, such as walkers,
poles, and standing frames
 motorized
wheelchairs, special feeding devices,
modified typewriters, and customized seating
Communication skills
 Bliss
symbols, talking typewriters, and specially
adapted computers including artificial intelligence
Drugs for spasticity:
 dantrolene
sodium, the benzodiazepines, and baclofen

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