Cerebral palsy: Difference between revisions
3amrbadawy (talk | contribs) No edit summary |
ClaireLewis (talk | contribs) No edit summary |
||
| (10 intermediate revisions by 5 users not shown) | |||
| Line 4: | Line 4: | ||
**Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age<ref>Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.</ref> | **Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age<ref>Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.</ref> | ||
*Associated with | *Associated with | ||
**Birth: hypoxia, placental abruption, prolonged labor, uterine rupture | **Birth: [[hypoxia]], [[placental abruption]], prolonged labor, [[uterine rupture]] | ||
**Child: jaundice/kernicterus, low-birth weight, prematurity | **Child: [[jaundice]]/kernicterus, low-birth weight, prematurity | ||
**Mother: infection (prenatal), infertility | **Mother: infection (prenatal), infertility treatment, multiple births, [[thyroid disorder]], [[seizure]] disorder | ||
= | ===Classification<ref>Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000</ref>=== | ||
==Classification<ref>Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000</ref>== | |||
*Spastic cerebral palsy is the most common type, ~80% of cases | *Spastic cerebral palsy is the most common type, ~80% of cases | ||
'''Spastic diplegia (30-40%)''' | |||
*Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities. | *Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities. | ||
'''Spastic hemiplegia (20-30%)''' | |||
*One side of the body effected, including an upper and lower extremity | *One side of the body effected, including an upper and lower extremity | ||
*Upper extremity spasticity effected more than lower extremity | *Upper extremity spasticity effected more than lower extremity | ||
**Double hemiplegia: when both arms are more involved than the legs | **Double hemiplegia: when both arms are more involved than the legs | ||
'''Spastic quadriplegia (10-15%)''' | |||
*Cerebral palsy affecting all 4 extremities and the trunk (full body) | *Cerebral palsy affecting all 4 extremities and the trunk (full body) | ||
'''Dyskinetic cerebral palsy''' | |||
*Athetoid, choreoathetoid, and dystonic | *Athetoid, choreoathetoid, and dystonic | ||
*Extrapyramidal signs characterized by abnormal movements; hypertonicity | *Extrapyramidal signs characterized by abnormal movements; hypertonicity | ||
'''Mixed cerebral palsy''' | |||
*Mixture of spastic and dyskinetic components without predominant area | *Mixture of spastic and dyskinetic components without predominant area | ||
'''Hypotonic cerebral palsy''' | |||
*Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes | *Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes | ||
'''Monoplegia''' | |||
*Rare: One limb involved, either an arm or a leg | *Rare: One limb involved, either an arm or a leg | ||
*Must rule out other causes. | *Must rule out other causes. | ||
==Clinical Features== | |||
*Abnormal muscle tone (most common) | |||
**Hypertonia > hypotonia | |||
*Intellectual disability (30-50%)<ref>Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.</ref> | |||
*Speech and language impairment | |||
*Ophthalmologic impairment | |||
*[[Hearing loss|Hearing impairment]] | |||
*Oromotor dysfunction | |||
*[[Epilepsy]] | |||
*Disease classified according to resting tone and limb involvement | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 51: | Line 51: | ||
*'''Neuromuscular weakness''' | *'''Neuromuscular weakness''' | ||
**UMN: | **UMN: | ||
*** [[CVA (Main)]] | ***[[CVA (Main)]] | ||
*** [[Hemorrhagic stroke]] | ***[[Hemorrhagic stroke]] | ||
**Spinal cord disease: | **Spinal cord disease: | ||
*** Infection ([[Epidural Abscess (Spinal)]]) | ***Infection ([[Epidural Abscess (Spinal)]]) | ||
*** Infarction/ischemia | ***Infarction/ischemia | ||
*** Trauma ([[Spinal Cord Syndromes]]) | ***Trauma ([[Spinal Cord Syndromes]]) | ||
*** Inflammation ([[Transverse Myelitis]]) | ***Inflammation ([[Transverse Myelitis]]) | ||
*** Tumor | ***Tumor | ||
**Peripheral nerve disease: | **Peripheral nerve disease: | ||
*** [[Guillain-Barre syndrome]] | ***[[Guillain-Barre syndrome]] | ||
*** [[Tick paralysis]] | ***[[Tick paralysis]] | ||
**NMJ disease: | **NMJ disease: | ||
*** [[Botulism]] | ***[[Botulism]] | ||
*** [[Organophosphate toxicity]] | ***[[Organophosphate toxicity]] | ||
*** [[Lambert-Eaton myasthenic syndrome]] | ***[[Lambert-Eaton myasthenic syndrome]] | ||
**Muscle disease: | **Muscle disease: | ||
*** [[Rhabdomyolysis]] | ***[[Rhabdomyolysis]] | ||
*'''Non-neuromuscular weakness''' | *'''Non-neuromuscular weakness''' | ||
**Can't miss diagnoses: | **Can't miss diagnoses: | ||
*** severe infection/[[Sepsis (Main)]] | ***severe infection/[[Sepsis (Main)]] | ||
*** [[Hypoglycemia]] | ***[[Hypoglycemia]] | ||
*** Periodic paralysis (electrolyte disturbance, K, Mg, Ca) | ***Periodic paralysis (electrolyte disturbance, K, Mg, Ca) | ||
****[[Hypokalemic periodic paralysis]] | ****[[Hypokalemic periodic paralysis]] | ||
****[[Thyrotoxic periodic paralysis]] | ****[[Thyrotoxic periodic paralysis]] | ||
*** Respiratory failure | ***Respiratory failure | ||
**Emergent Diagnoses: | **Emergent Diagnoses: | ||
*** Symptomatic [[Anemia]] | ***Symptomatic [[Anemia]] | ||
*** Severe dehydration | ***Severe dehydration | ||
*** [[Hypothyroidism]] | ***[[Hypothyroidism]] | ||
*** Malignancy | ***Malignancy | ||
== | ==Evaluation== | ||
*Rule out [[Baclofen withdrawal]] in patient being treated for spasticity with Baclofen pump. | |||
==Management== | ==Management== | ||
| Line 94: | Line 95: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Neurology]] | |||
[[Category:Pediatrics]] | |||
Latest revision as of 18:31, 14 September 2019
Background
- Leading cause of childhood disability effecting function and development.
- Defined as a group of disorders involving motor or postural abnormalities that are noted during early development[1]
- Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age[2]
- Associated with
- Birth: hypoxia, placental abruption, prolonged labor, uterine rupture
- Child: jaundice/kernicterus, low-birth weight, prematurity
- Mother: infection (prenatal), infertility treatment, multiple births, thyroid disorder, seizure disorder
Classification[3]
- Spastic cerebral palsy is the most common type, ~80% of cases
Spastic diplegia (30-40%)
- Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities.
Spastic hemiplegia (20-30%)
- One side of the body effected, including an upper and lower extremity
- Upper extremity spasticity effected more than lower extremity
- Double hemiplegia: when both arms are more involved than the legs
Spastic quadriplegia (10-15%)
- Cerebral palsy affecting all 4 extremities and the trunk (full body)
Dyskinetic cerebral palsy
- Athetoid, choreoathetoid, and dystonic
- Extrapyramidal signs characterized by abnormal movements; hypertonicity
Mixed cerebral palsy
- Mixture of spastic and dyskinetic components without predominant area
Hypotonic cerebral palsy
- Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes
Monoplegia
- Rare: One limb involved, either an arm or a leg
- Must rule out other causes.
Clinical Features
- Abnormal muscle tone (most common)
- Hypertonia > hypotonia
- Intellectual disability (30-50%)[4]
- Speech and language impairment
- Ophthalmologic impairment
- Hearing impairment
- Oromotor dysfunction
- Epilepsy
- Disease classified according to resting tone and limb involvement
Differential Diagnosis
Weakness
- Neuromuscular weakness
- UMN:
- Spinal cord disease:
- Infection (Epidural Abscess (Spinal))
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Tumor
- Peripheral nerve disease:
- NMJ disease:
- Muscle disease:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- severe infection/Sepsis (Main)
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Malignancy
- Can't miss diagnoses:
Evaluation
- Rule out Baclofen withdrawal in patient being treated for spasticity with Baclofen pump.
Management
Disposition
See Also
External Links
References
- ↑ Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51.
- ↑ Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.
- ↑ Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000
- ↑ Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.