Management and diagnosis

1. CEREBRAL PALSY

2. Definition
 Is a disorder of posture and movement due to a non
progressive lesion in the motor pathways of the developing
brain.
 the underlying cerebral pathology is permanent and non
progressive.
 CP is due to brain malformation or damage affecting those
areas involved in the motor function.

4. However, in the developing child, the resulting
clinical picture is not static.
 Can be caused any time during pregnancy,
delivery, or up to 5 year of age.
 It interferes with normal motor development
because it arises in early life
 It is often associated with other neurological and
mental problems

5. Causes can be :
- Antenatal; cerebral dysgenesis, cerebral
malformation, congenital infection, congenital
cysts, failure of migration of the grey matter
and hypoxia-ischemia.
- Intrapartum; hypoxic ischemic
encephalopathy and birth trauma.
- Postnatal; cerebral ischemia, IVH,
hydrocephalus, trauma, non accidental injury,
hyperbilirubinaemia, meningitis, encephalitis,
near drowning, hypoglycemia, cerebrovascular
accidents, poisoning, toxins

7. Classification:
 1. Spastic cerebral palsy starts with
hypotonia progressing to spasticity
 3 types:
- hemiplegia is unilateral involvement arm >
leg
- diplegia legs greater than arms
- quadreplegia all limbs affected.
 Clinical findings: Hypertonia, abnormal brisk
tendon jerks, ankle clonus, and extensor
plantar responses.

8.  2. Dystonic( athetoid) cerebral palsy is
characterised by irregular and involuntary
movement.
 These may be continuous or occur on
voluntary active movement.
 Athetosis is the commonest form with slow
purposeless muscle movements and extensor
spasms.

9.  3. Ataxic cerebral palsy is associated with
hypotonia, weakness, uncoordinated movements
and intentional tremor.
 4. Mixed cerebral palsy were all the above types
present in same patient

11. Clinical features
 Delayed milestones
 Abnormal tone in infancy
 Abnormal gait
 Feeding difficulties
 Developing delay (language, social)
 Persistence of primitive reflexes.

13.  Usually not diagnosed until several months have
passed when it becomes obvious that motor
development is abnormal or delayed.
 Infant may be brought for no head control at 3
months.

15. Associated features:
 Learning impairment
 Visual impairment, strabismus
 Hearing impairment
 Speech and language difficulties,
 Behavioral problems
 Epilepsy

16. Investigations:
1. Cranial US
2. CT Scan
3. Metabolic screen
4. Hearing assessment
5. Ophthalmological
assessment

17. Management
 Early treatment is necessary
 To avoid contractures
 To stimulate learning of unaffected parts of the brain

18. Requires multidisciplinary approach
 Specialists involved are:
 Occupational therapist,
 physiotherapist,
 speech therapist,
 social worker, teacher,
 developmental psychologist,
 pediatrician,
 orthopedic surgeon,
 neurologist,
 ophthalmologist and
 audiologist.

19.  But every clinician can do a lot in cooperation with
the care taker!
 Teach how to avoid contractures, how to stimulate
motor and psychological development.
 Baclofen can be used if severe spasm.
 Close supervision of nutritional status
 Treatment of convulsions if present