[32] Cerebral Palsy Flashcards Preview

A - MSRA Paediatrics [15] > [32] Cerebral Palsy > Flashcards

Flashcards in [32] Cerebral Palsy Deck (64)
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1
Q

What is cerebral palsy?

A

A chronic disorder or movement and/or posture that presents early and continues throughout life

2
Q

When does cerebral palsy present?

A

Before 2 years old

3
Q

What is cerebral palsy characterised by?

A

Abnormal muscle tone, reflexes, or motor development

4
Q

What is the incidence of cerebral palsy?

A

It occurs in about 2.1 per 1000 live births

5
Q

What are the sub-types of cerebral palsy classified on the basis of?

A

The specific problems present

6
Q

What are the sub-types of cerebral palsy?

A
  • Spastic cerebral palsy
  • Ataxic cerebral palsy
  • Athetoid cerebral palsy
7
Q

What is spastic cerebral palsy?

A

Those with stiff muscles

8
Q

What is ataxic cerebral palsy?

A

Those with poor co-ordination

9
Q

What is athetoid cerebral palsy?

A

Those with writhing movement

10
Q

Do the sub-types of cerebral palsy occur on their own or together?

A

Most children have a mixed disorder

11
Q

What is the underlying mechanism of spastic cerebral palsy

A

Damage to the upper motor neurone (pyramidal or corticospinal tract) pathway

12
Q

What is unilateral spastic cerebral palsy most commonly caused by?

A

Neonatal stroke

13
Q

What is bilateral (quadriplegic) spastic cerebral palsy most commonly caused by?

A

Perinatal hypoxic-ischaemic encephalopathy

14
Q

What is bilateral (diplegic) spastic cerebral palsy most commonly caused by?

A

Preterm birth, due to periventricular brain damage

15
Q

What is the underlying mechanism of dyskinetic cerebral palsy?

A

Damage or dysfunction to the basal ganglia, or their associated pathway

16
Q

What is dyskinetic cerebral palsy most commonly caused by?

A

Hypoxic-ischaemic encepahlopathy at term

17
Q

What is the underlying mechanism of ataxic cerebral palsy?

A

Most cases are genetically determined

18
Q

What is the underlying mechanism of cerebral palsy?

A

Caused by abnormal development or damage to parts of the brain that control movement, balance, and posture

19
Q

When does damage to the brain causing cerebral palsy occur?

A

Most often, problems occur during pregnancy, however they may occur during childbirth or shortly after birth

20
Q

What % of cases of cerebral palsy are thought to have an inherited genetic cause?

A

About 2%

21
Q

Is there always an identifiable cause in cerebral palsy?

A

No

22
Q

Give some typical causes of cerebral palsy?

A
  • Problems with intra-uterine development
  • Hypoxia of the brain
  • Birth trauma during labour and delivery
  • Complications around birth or during childhood
23
Q

Give 3 examples of problems with intrauterine development that can cause cerebral palsy

A
  • Exposure to radiation
  • Infection
  • Fetal growth restriction
24
Q

Give 2 examples of causes of hypoxia to the brain that can cause cerebral palsy

A
  • Thrombotic events

- Placental conditions

25
Q

What are the risk factors for cerebral palsy?

A
  • Pre-term birth
  • Being a twin
  • Certain infections during pregnancy, e.g. toxoplasmosis, rubella
  • Exposure to methylmercury during pregnancy
  • Difficult delivery
  • Head trauma during first few years of life
26
Q

When will many children who develop CP be identified as being at risk?

A

In the neonatal period

27
Q

What are the early features of CP?

A
  • Abnormal limb and/or trunk posture and tone in infancy, with delayed motor milestones
  • Feeding difficulties, with oromotor incoordination, slow feeding, gagging, and vomiting
  • Abnormal gait once walking is achieved
  • Asymmetric hand function before 12 months of age
28
Q

How is CP now categorised?

A

According to neurological features

29
Q

What are the different categories of CP?

A
  • Spastic
  • Dyskinetic
  • Ataxic
30
Q

What are the main features of spastic cerebral palsy?

A
  • Persistently increased limb tone

- Brisk deep tendon reflexes and extensor plantar responses

31
Q

What are the types of spastic CP?

A
  • Unilateral
  • Bilateral (quadriplegia)
  • Bilateral (diplegia)
32
Q

What is affected in unilateral spastic cerebral palsy?

A

Arm or leg (arm usually more than leg)

33
Q

When do children with unilateral spastic cerebral palsy present?

A

4-12 months

34
Q

How do children with unilateral spastic cerebral palsy present?

A
  • Fisting of affected hand
  • Flexed arm and pronated forearm
  • Asymmetrical reaching
  • Tip-toe walk on affected side
35
Q

What is affected in bilateral (quadriplegic) spastic cerebral palsy?

A

All 4 limbs, often severely, as well as the trunk

36
Q

What results from the trunk being involved in bilateral (quadriplegic) spastic cerebral palsy?

A
  • Extensor posturing
  • Poor head control
  • Low central tone
37
Q

What is opisthosomas? (if its not a spider just in case the word in an exam if its real)

A

Extensor posturing

38
Q

What is bilateral (quadriplegic) spastic cerebral palsy associated with?

A
  • Seizures
  • Microcephaly
  • Moderate or severe intellectual impairment
39
Q

What is bilateral (diplegic) spastic cerebral palsy?

A

When all 4 limbs are affected, but legs are affected to a much greater degree than arms, so hand function may appear to be relatively normal

40
Q

What does dyskinesia refer to?

A

Movements that are involuntary, uncontrolled, occasionally stereotyped, and often more evident with active movement or stress

41
Q

Describe the muscle tone in dyskinetic cerebral palsy

A

Variable

42
Q

Describe the motor reflexes in dyskinetic cerebral palsy

A

Primitive motor reflex patterns predominate

43
Q

What may dyskinesia be described as?

A
  • Chorea
  • Athtosis
  • Dystonia
44
Q

What is chorea?

A

Irregular, sudden, and brief non-repetitive movements

45
Q

What is athetosis?

A

Slow writing movements occurring more distally

46
Q

What is dystonia?

A

Simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles, often given twisted appearance

47
Q

How do children with dyskinetic cerebral present?

A
  • Floppiness
  • Poor trunk control
  • Delayed motor development
48
Q

When do abnormal movements appear in dyskinetic cerebral palsy?

A

Towards the end of the first year of life

49
Q

How does ataxic cerebral palsy present initially?

A
  • Early trunk and limb hypotonia
  • Poor balance
  • Delayed motor development
50
Q

What features may be present later in ataxic cerebral palsy?

A
  • Incoordinate movements
  • Intention tremor
  • Ataxic gait
51
Q

What is the diagnosis of cerebral palsy based on?

A

Mainly history and physical examination, including general movements assessment

52
Q

What does a general movements assessment involve?

A

Measuring movements that occur spontaneously

53
Q

When is a general movements assessment most accurate?

A

At less than 4 months of age

54
Q

What tests are done once a person has been diagnosed with CP?

A

Further diagnostic tests are optional, and may include CT/MRI

55
Q

What is the purpose of a CT/MRI in CP?

A
  • Determine cause of CP
  • Suggest timing of initial damage
  • Reveal treatable conditions, e.g. hydrocephalus, AV malformation
56
Q

What are the differential diagnoses for CP?

A
  • Temporary problems with muscle tone or control
  • Metabolic disorders
  • Fragile X syndrome
  • Tumours of conus and cauda equina
  • Vascular malformations of spinal cord
57
Q

Give 2 metabolic disorders that are differentials for CP

A
  • Metabolic myopathies

- Metabolic neuropathies

58
Q

Is there a cure for cerebral palsy?

A

No

59
Q

What are the types of management for CP?

A
  • Supportive treatments
  • Medications
  • Surgery
60
Q

What can some children achieve with appropriate management?

A

Near normal adult life

61
Q

What are the management options for CP?

A
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medications to help relax stiff muscles
  • Surgery
  • External braces
  • Assistive technology
62
Q

What medications can be used to help relax stiff muscles in CP?

A
  • Diazepam
  • Baclofen
  • Botulinum toxin
63
Q

What are the surgical options in CP?

A
  • Lengthening muscles

- Cutting overly active nerves

64
Q

What impairments are children with CP at increased risk of?

A
  • Vision
  • Difficulty communicating
  • Learning disabilities
  • Epilepsy
  • Nutrition
  • Psychiatric

Decks in A - MSRA Paediatrics [15] Class (115):