Cerebral Palsy

Key Features

Essentials of Diagnosis

• Describes a chronic, static impairment of muscle tone, strength, coordination, or movements

• Condition is nonprogressive

• Originates from some type of cerebral insult or injury before birth, during delivery, or in the perinatal period

General Considerations

• Depending on the type and severity of the motor deficits, associated neurologic deficits or disorders may occur

  • Seizures in up to 50%

  • Mild mental retardation in 26%

  • Severe retardation in up to 27%

• Disorders of language, speech, vision, hearing, and sensory perception are found in varying degrees and combinations

• Blindness, deafness, or epilepsy often coexist

• Some form of cerebral palsy occurs in about 0.2% of neonatal survivors

• The fundamental course, severity, precise manifestations, and prognosis vary widely

Clinical Findings

Symptoms and Signs

• Most common forms of cerebral palsy (75% of cases) involve spasticity

• Ataxia

  • Second most common form of cerebral palsy

  • Accounts for about 15% of cases

  • Frequently affects fine coordinated movements of the upper extremities, but may also involve lower extremities and trunk

• Choreoathetosis or dystonia accounts for 5% of cases

• Persistent hypotonia without spasticity for 1% of cases

• Microcephaly is frequently present

• In patients with hemiplegia, the affected arm and leg may be smaller and shorter than the unaffected limbs

• Cataracts, retinopathy, and congenital heart defects may be indicative of congenital infections such as cytomegalovirus and rubella

Differential Diagnosis

• Intrauterine hypoxia

• Intrauterine bleeding

• Infections

• Toxins

• Congenital brain malformations

• Obstetric complications (including birth hypoxia)

• Kernicterus

• Neonatal hypoglycemia

• Metabolic disorders

• Small number of genetic syndromes

Diagnosis

• Appropriate laboratory studies depend on the history and physical findings

• MRI scans may be helpful in understanding the full extent of cerebral injury

• Neuroimaging results occasionally suggest specific etiologies (eg, periventricular calcifications in congenital cytomegalovirus infections or brain malformations such as pachygyri or lissencephaly)

• Genetic and metabolic testing should be targeted based on history or MRI findings

Treatment

• Therapy is directed at assisting the child to attain maximal neurologic functioning, with appropriate physical, occupational, and speech therapy

• Orthopedic monitoring and intervention and special educational assistance may contribute to an improved outcome

• Spasticity and seizures can be managed with medications or botulinum toxin

Outcome

Prognosis

• Depends on the child's IQ, severity of the motor deficits, etiology of cerebral palsy, and degree of incapacity

• In severely affected children, aspiration, pneumonia, or other intercurrent infections are the most common causes of death

• Patients with mild cerebral palsy may improve with age

• Some patients experience resolution of motor deficits by age 7 years

References