Cerebral Palsy

  • disorder of movement and posture due to non-progressive lesion of motor pathways in the developing brain

  •  range of predominantly motor deficits arising from pre- or peri-natal insults

Epidemiology

  • 2:1000 live births

Typical Patient

  • Neonate or infant

Symptoms / Signs

  • motor neurological deficits

    • abnormal tone and posturing in early infancy

    • feeding difficulties (oromotor incoordination)

    • delayed motor milestones

    • abnormal gait

    • developmental delay

      • language

      • social skills

    • hand-preference < 12 months old

    •  

  • may be learning / behavioural difficulties

  • ?squints

  • ?epilepsy

Problems associated with brain injury

  • associated learning impairment (60%)

  • visual impairment (20%)

  • squints (30%)

  • hearing loss (20%)

  • speech and language disorders

  • behavioural disorders

  • epilepsy (40%)

Variants

  • Spastic diplegia

  • Spastic hemiplegia

  • Athetoid cerebral palsy

  • Tetraplegia

  • purely ataxic

  • mixed

Pathology

Risk factors

Antenatal

  • fetal hypoxia / infection (<10%)

  • Developmental abnormalities

  • Twins

  • Maternal age

Perinatal

  • Prematurity

  • Postmaturity

  • Traumatic delivery with neonatal intracranial haemorrhage

Postnatal

  • Pre-term

    • hypoxia

    • hypoglycaemia

    • cerebral ischaemia

    • haemorrhage

    • hypothermia

  • Full-term

    • infection

    • trauma

    • kernicterus

Investigations

Treatments

  • physio- / occupational therapy

  • address educational needs

  • botulinum toxin (to relieve spasticity)

  • surgical correction of squints, contractures, etc.

Prognosis

  • Normal life span

  • May be slightly reduced due to respiratory infection

Complications

  • contractures

 

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