This document discusses cerebral palsy (CP), defining it as a group of non-progressive movement disorders caused by brain insults during development. It covers the etiology, pathology, clinical features and classifications of CP. Etiology includes congenital, acquired, and infective causes. Pathology includes subependymal hemorrhage, periventricular leukomalacia, and hypoxic-ischemic damage. Clinical features include motor control disorders along with cognitive, sensory, and behavioral symptoms. Diagnosis involves developmental screening and clinical exams. Management is multidisciplinary, including therapies, medications, and sometimes surgery. Prevention focuses on good antenatal and neonatal care.
3. 1.INTRODUCTION
a. 1862 JHON HITLER DISCOVERED
b. FREUD COIND TERMINOLOGY
c. WHAT IS CEREBRAL PALSY
d. WHAT IS NOT CEREBARL PALSY
e. HOW BIG IS THE PROBLEM OF CEREBRAL PALSY
1.2 to 2.5 per 1000 school age children
Incidence 2 per 1000 live births.
25 lacks in India
7 lacks in USA.
4. DEFINATION
CP does not refer to a single entity but is a group of
non progressive disorders of heterogenous etiologies
that manifest as abnormalities of movement of posture
resulting from insult to developing C.N.S which occur
during prenatal, natal, post natal period till one
month of age.
5. ETIOLOGY
THREE BROAD GROUPS
1. CONGENITAL CAUSES OF CEREBRA PALSY.
2. ACQUIRED CAUSES OF CEREBRAL PALSY.
10 TO 18 % OF CEREBRAL PALSY
3. INFECTIVE CAUSES OF CEREBRAL PALSY
6. 1.CONGENITAL CAUSES OF CEREBRAL PALSY
a. Prematurity.
b. L.B.N
c. Small for her gestational age
d. Intrauterine hypoxia and prenatal hypoxia
e. Maternal malnutrition
f. Placental infarction
g. Congenital malformations
h. Bilirubin encephalopathy and hypoglycemia
i. Genetic and chromosomal
J. Environmental factors
9. PATHOLOGY CLASSIFICATION
A. SUB EPENDYMAL HEMORRHAGE
premature 25-35 weeks G.A
L.B.W 1.8 KG or Less.
Lesser degree of hemorrhage – Survive and develop
hydrocephalus.
HAGBERGA - SWEEDISH
Half patients with spastic Diplegia had matrix hemorrhages
P.L.M
10. B. PERIVENTICULAR LEUCOMALACIA
At water shed zones of cortical and central arteries
represents venous infarcts.
May develop in premature and full term infants
suffering hypotension and apnea.
High risk 28 weeks G.A.
Survivors develop cerebral Hemiplegia or Diplegia &
cognitive impairment.
11. C. HYPOXIC ISCHEMIC DAMAGE-
NEONATAL ENCEPHALOPATHY
FENICHEL & SARNAT 1976
Mild, Moderate, Severe HIE
For moderate & severe HIE
Risk factors are Toxemia, Ante partum
hemorrhage, SGA, preterm.
• Some are term infants develop HIE birth process may
or may not be abnormal
• SIGMOND FREUD THEORY
12. INTERM INFANTS CAUSES OF HIE ARE MAINLY
a. T.S.G.A
b. Toxemia of pregnancy
c. Placental infarction
d. Intrauterine asphyxia
Results in cerebral Diplegia other spastic, dystonic,
ataxic syndromes.
D. Where a, b, c factors are not operative
13. RECENT STUDY OF COWAN & COLLEAGUES
MRI in neonatal encephalopathy excluding major
congenital malformations, chromosomal
abnormalities.
80 % no established lesion or cerebral atrophy in
neonatal encephalopathy.
But in neonatal seizures 69% antenatal damage.
Clinical syndromes due to pathology: -
Matrix, hemorrhage, PVL, HIE, Kernicterus is Spastic
Diplegia.
14. Hypoxic ischemic injury in term or preterm infants
take form of :
a. Hemiplegia.
b. Double Hemiplegia.
c. spastic ataxic syndromes.
Spastic quadriplegia & MR due to major insuiits like
intrapartum asphyxia & fetal distress.
Pathology is ulegyric sclerotic cortex in white matter of
parietal and posterior frontal lobes.
15. MAJOR CONTROL & POSITVE DISORDERS
CLASSIFIED AS
1. Spastic form
a. Spastic Quadriplegia
b. Spastic Diplegia
c. Spastic Hemiplegia.
2. Hypotonic form.
3. Ataxic form.
4. Dyskinetic form.
a. Choreoathetosis.
b. dystonic or both.
5. Mixed form
Spastic & choreoathetotic form
16. CLINICAL FEATURES & CLASSIFICATION
Mainly motor control disorders with accompanied symptoms.
1. Cognitive
2. Sensory visual hearing.
3. Communication defect.
4. Growth failure
5. Seizures
6. Behavior & emotional problems.
a. attention deficit.
b. depression.
c. dependency.
d. defective sexuality.
e. low self esteem.
17. DIAGNOSIS
Developmental Screening
H/O High risk infant.
H/O drug addiction in the mother.
MR or psychotic illness of mother.
Disturbed family
Dynamic
Clinical Exam:
see development mile stones:
Eyes, Ears, Musculoskeletal survey, Head
circumference.
Observe early pointers to CP
23. PREVENTION
Good antenatal care.
Fetal monitoring.
Early C sections.
Use of steroids to maturity of fetus.
First 3 days after delivery:
INDOMETHACIN, ETHAMSYLATE, IM VITE.
CORTICOSTEROIDS :BETAMITHASONE.
Neonatal Resuscitation.