Cerebral Palsy
CP
SUMMARISED up to clinical manifestations in Nelsons
Definition: A permanent static encephalopathy causing disturbance of posture and movement, initiated by a non-progressive insult the the developing brain. (NB consequences can progress e.g. spasticity, scoliosis..)
Incidence: 3.6:1000 (1.4:1 M:F)
most common and costly chronic motor disability
Aetiology: Insult is most commonly in the antenatal period (80%) v intrapartum (10%)
Dx
General movement assessment ?3-6months
Indications:
Types
Spastic diplegia (35%): PVL/hydrocephalus
Spastic quad (20%): PVL/hydrocephalus/multicystic encephalomalacia
Spastic Hemiplegia (25%) Stroke (throm/inf), unilateral malformation
Dyskinetic (15%) choreoathetoid/dystonia: asphyxia, kernicterus (deep)
Ataxic (rare)
(hypotonic: sometime used to describe the early presentations before spasticity/dyskinesia has developed)
Motor assessment: Global motor function measure-66 > indicates functional capacity in home and school
DDx
choreoathetoid
risk x6 in twins, x 30 in triples
Bwt outside 3-97 centiles
Limits activity
Epilepsy
Musculoskeletal problems
Severity: wild range from no cognitive to severe cognitive dysfunction
SUMMARISED up to clinical manifestations in Nelsons
Definition: A permanent static encephalopathy causing disturbance of posture and movement, initiated by a non-progressive insult the the developing brain. (NB consequences can progress e.g. spasticity, scoliosis..)
Incidence: 3.6:1000 (1.4:1 M:F)
most common and costly chronic motor disability
Aetiology: Insult is most commonly in the antenatal period (80%) v intrapartum (10%)
- Genetic: IL-6 gene,
- Metabolic
- Ischemic: Intracerebral haemorrhage, periventricular leukomalacia (white matter necrosis)
- Prem: more likely PVL, Term > HIE
- Trauma
- Infection (40%): chorioamnionitis (chorion (placenta) amnion (sac), UTI
- Kernicterus
Dx
General movement assessment ?3-6months
Indications:
- 32 weeks
- Hie
- Meningitis
- Ivh
- Concerns for development
Types
Spastic diplegia (35%): PVL/hydrocephalus
Spastic quad (20%): PVL/hydrocephalus/multicystic encephalomalacia
Spastic Hemiplegia (25%) Stroke (throm/inf), unilateral malformation
Dyskinetic (15%) choreoathetoid/dystonia: asphyxia, kernicterus (deep)
Ataxic (rare)
(hypotonic: sometime used to describe the early presentations before spasticity/dyskinesia has developed)
Motor assessment: Global motor function measure-66 > indicates functional capacity in home and school
DDx
choreoathetoid
- Lesch-Nyhan disease (hyperuricemia, self-biting..)
risk x6 in twins, x 30 in triples
Bwt outside 3-97 centiles
Limits activity
- handedness usually established by 3yo, earlier ?CP v Brachial plexus v OM
Epilepsy
Musculoskeletal problems
- Scoliosis
- Hip Dislocation (most common in spastic quad)
Severity: wild range from no cognitive to severe cognitive dysfunction