Cerebral palsy: Difference between revisions

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*Defined as a group of disorders involving motor or postural abnormalities that are noted during early development<ref>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.</ref>
*Defined as a group of disorders involving motor or postural abnormalities that are noted during early development<ref>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.</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>
**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
**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<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 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==
==Clinical Features==
*Mental retardation (30-50%)<ref>Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.</ref>
*Abnormal muscle tone (most common)
*Epilepsy (15-60%)
**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==
===[[Weakness]]===
*'''Neuromuscular weakness'''
**UMN:
***[[CVA (Main)]]
***[[Hemorrhagic stroke]]
**Spinal cord disease:
***Infection ([[Epidural Abscess (Spinal)]])
***Infarction/ischemia
***Trauma ([[Spinal Cord Syndromes]])
***Inflammation ([[Transverse Myelitis]])
***Tumor
**Peripheral nerve disease:
***[[Guillain-Barre syndrome]]
***[[Tick paralysis]]
**NMJ disease:
***[[Botulism]]
***[[Organophosphate toxicity]]
***[[Lambert-Eaton myasthenic syndrome]]
**Muscle disease:
***[[Rhabdomyolysis]]
*'''Non-neuromuscular weakness'''
**Can't miss diagnoses:
***severe infection/[[Sepsis (Main)]]
***[[Hypoglycemia]]
***Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
****[[Hypokalemic periodic paralysis]]
****[[Thyrotoxic periodic paralysis]]
***Respiratory failure
**Emergent Diagnoses:
***Symptomatic [[Anemia]]
***Severe dehydration
***[[Hypothyroidism]]
***Malignancy


==Diagnosis==
==Evaluation==
*Rule out [[Baclofen withdrawal]] in patient being treated for spasticity with Baclofen pump.


==Management==
==Management==
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==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

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

Evaluation

Management

Disposition

See Also

External Links

References

  1. 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.
  2. Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.
  3. Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000
  4. Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.