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Cerebral palsy
From WikEM
Contents
Background
- Leading cause of childhood disability effecting function and development.
- Defined as a group of disorders involving motor or postural abnormalities that are noted during early development[1]
- Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age[2]
- Associated with
- Birth: hypoxia, placental abruption, prolonged labor, uterine rupture
- Child: jaundice/kernicterus, low-birth weight, prematurity
- Mother: infection (prenatal), infertility treatment, multiple births, thyroid disorder, seizure disorder
Classification[3]
- Spastic cerebral palsy is the most common type, ~80% of cases
Spastic diplegia (30-40%)
- Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities.
Spastic hemiplegia (20-30%)
- One side of the body effected, including an upper and lower extremity
- Upper extremity spasticity effected more than lower extremity
- Double hemiplegia: when both arms are more involved than the legs
Spastic quadriplegia (10-15%)
- Cerebral palsy affecting all 4 extremities and the trunk (full body)
Dyskinetic cerebral palsy
- Athetoid, choreoathetoid, and dystonic
- Extrapyramidal signs characterized by abnormal movements; hypertonicity
Mixed cerebral palsy
- Mixture of spastic and dyskinetic components without predominant area
Hypotonic cerebral palsy
- Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes
Monoplegia
- Rare: One limb involved, either an arm or a leg
- Must rule out other causes.
Clinical Features
- Abnormal muscle tone (most common)
- Hypertonia > hypotonia
- Mental retardation (30-50%)[4]
- Speech and language impairment
- Ophthalmologic impairment
- Hearing impairment
- Oromotor dysfunction
- Epilepsy
- Disease classified according to resting tone and limb involvement
Differential Diagnosis
Weakness
- Neuromuscular weakness
- UMN:
- Spinal cord disease:
- Infection (Epidural Abscess (Spinal))
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Tumor
- Peripheral nerve disease:
- NMJ disease:
- Muscle disease:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- severe infection/Sepsis (Main)
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Malignancy
- Can't miss diagnoses:
Evaluation
- R/o Baclofen withdrawal in patient being treated for spasticity with Baclofen pump.
Management
Disposition
See Also
External Links
References
- ↑ Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51.
- ↑ Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.
- ↑ Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000
- ↑ Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.
