Cerebral palsy (CP) is divided into four major classifications: spastic, ataxic, dyskinetic, and mixed. The most common type is spastic CP, which is caused by damage to the pyramidal region and results in hypertonia, increased reflexes, and an abnormal gait. CP can be caused prenatally by factors like prematurity or infection, perinatally by hypoxic ischemic encephalopathy or kernicterus, or postnatally by infection or trauma. Diagnosis involves assessing for signs of abnormal muscle tone and movement, as well as investigations like brain imaging. Treatment requires a multidisciplinary approach including management of spasticity, associated issues like seizures

1. Reda Said Ramadan
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4. Classification
spastic
Ataxic
Dyskinetic
Mixed
• Cerebral palsy (CP) is divided into four major
classifications

5. Topographic classification of spasic CP

7. • The most common type .
• It is due to pyramidal region affection(leading
to UMNL manifestaions)
• Clinically : Hypertonia of klasp knife variety
with increased deep tendon reflexes and +ve
Babinski sign.

8. • Spastic hemiplegia is one side being affected.
• Contralateral side .
• This is the most common type following
antenatal stroke.

9. • Spastic diplegia is the lower extremities affected,
with little to no upper-body spasticity.
• people with spastic diplegia have
a scissors gait.
• It is the most common type following prematurity

10. • Spastic monoplegia is one single limb being
affected.
• Spastic triplegia is three limbs being affected.

11. • All four limbs more or less equally affected.
• Spastic lower limbs with
difficult hand manipulation
• Mostly following prematurity

12. • caused by damage to the cerebellum.
• occurring in at most 20-30% of all cases.
• clinically: hypotonia , tremors,ataxic
gait,staccato speech and dysmetria.

13. • Due to extrapyramidal region affection.
• Accounts for 10% of CP cases.
• Clinically: hypertonia of lead-pipe or cog-
wheel with involuntary movements as chorea,
athetosis,ballismas or torsion dystonia.
• This type is seen following kernicterus.

14. • There may be a combination of the above
types for any one person.

15. Causes(Risk factors)of CP
Prenatal
causes
Perinatal
causes
Postnatal
causes

16. Prenatal causes (Risk factors)
• Prematurity
• Intrauterine infections(TORCH)
• Congenital CNS malformations
• Eclampsia or pre-eclampsia
• Uterine bleeding
• Placental insufficiency
• Small for gestation age
• Uncontrolled gestation DM
• Maternal choronic diseases
• In vitro fertilization babies
The most common causes for CP

17. Perinatal causes(Risk factors)
• Hypoxic ischemic encephalopathy
• Respiratory anoxia(e.g. respiratorydistress)
• Obestructed labor
• Premature rupture of membranes
• Neonatal sepsis and meningitis
• Kernicterus
• Intracranial hemorrhage

18. Postnatal causes(Risk factors)
• CNS infection as meningitis and encephalitis
• Intracranial trauma(e.g. child abuse)
• Severe dehydraion ± hypernatremia

19. Signs and symptoms CP
• Delayed milestones
• Persistence of primitive reflexes
• Developing handedness before age 18 months
• Abnormal muscle tone (spastic or floppy)
• Abnormal movements
• Skeletal deformities ( scoliosis)
• Joint contracture

20. Other symptoms
• Mental retardation
• Seizures
• Swallowing problems(at risk of aspiration)
• Hearing loss
• Vision problems(strabismus , are nearsighted)
• Dental problems
• Bowel and bladder control problems
• Speech disorders

21. Diagnosis
Clinical
manifestation
investigaions

22. Levine (poster)criteria for diagnosis of
CP
P…..posture and abnormal movement pattern .
O….oropharyngeal problem
S……strabismus
T ……tone (increased or decreased in muscles)
E………evolution response …persistent primitive
reflexes and failure to develop protective
reflexes
R……..reflexes , deep tendon reflex increase ,
planter reflex up going

23. investigation
• Various blood and urine
tests (chemical,
hormonal, or metabolic
problems).
• karyotype analysis and
specific DNA testing
(genetic syndrome).
• Ultrasound of the brain
• CT scan of the brain
• MRI of the brain( preferred
test)
• MRI of the spinal cord
• EEG
• EMG and nerve coduction
studies.

24. Treatement
Multi-disciplinary team work
Management of spasticity
Management of associated problems as epilepsy
Family counseling

25. Multi-disciplinary team work
pediatrician
neurologist
psychiatrist
Physio
tharapist
Speech
therapist
ophthalmol
ogist

26. Management of spasticity
• Dopaminergic drugs : levodopa-carbidopa(sinemet)
• Muscle relaxants: e.g. baclofen(lioresal)
• Penzodiazepine:e.g. diazepam(valium)
• Botulinum toxin injection: widely known as BOTOX

27. Management of seizure
• Anticonvulsants: stop seizure and prevent
recurrence
• Benzodiazepam as diazepam: stop seizures
when they are freqent or prolonged