CEREBRAL PALSY for mbbs student 500l classs

CEREBRAL PALSY
DR. AZIH NNAEMEKA KELSEY

11/17/2024 2
OUTLINE
 INTRODUCTION
 EPIDEMIOLOGY
 RISK FACTORS/AETIOLOGY
 CLASSIFICATION
 CLINICAL EVALUATION
 NEUROIMAGING
 TREATMENT
 APPROACH TO PREVENTION
 COMPLICATION
 PROGNOSIS

11/17/2024 3
INTRODUCTION
Cerebral palsy (CP): ‘Brain Paralysis
The leading cause of Childhood
disability affecting function and
development
A form of static encephalopathy (not a
progressive encephalopathy)

11/17/2024 4
DEFINITION:
Cerebral Palsy is a diagnostic term used
to describe a group of permanent
disorders in the development of
movement and posture causing activity
limitation that are attributed to non-
progressive disturbances in the
developing fetal or infant brain.
It is primarily a motor disorder.

11/17/2024 5
often accompanied by disturbances of:
Sensation
Language/Communication
Cognition/Problem-solving
Behaviour
Others:
Epilepsy
Intellectual disability
Skeletal malformations

11/17/2024 6
Causative brain lesions occur from
foetal/neonatal life to age 3 years.
Diagnosis is best made beyond 3yrs,
typical at age 5yrs.

11/17/2024 7
EPIDEMIOLOGY
Incidence: 3.6 per 1,000 children
M:F is 1.4:1
Prevalence is increased in ELBW at 15/100
Associated with:
Epilepsy in 15 - 60%
Intellectually disability in 30 – 50%

11/17/2024 8
RISK FACTORS/AETIOLOGY
Antenatal factors affecting brain
development(70 – 80%)
Perinatal Asphyxia
Preterm delivery
Multiple Pregnancy(Twins 5 – 8X:
Triplets 20 – 47X higher than Singleton)
Intrauterine exposure to maternal
infection

11/17/2024 9
CLASSIFICATION
Physiologic (resting tone)
Topographic taxonomy
2 main classes:
Spastic CP (Cortex/Pyramidal)
Extrapyramidal/Athetoid/Choreoathetoid/
Dyskinetic CP

11/17/2024 10
SPASTIC CP
Accounts for 80% of CP
Characteristics:
Spasticity (velocity-dependent increased tone)
Hyper-reflexia
Clonus
Babinski response

11/17/2024 11
SPASTIC HEMIPLEGIA
Clinical features:
One side of the body affected
Upper limb affected more than lower
Early hand preference
Delayed walk (18 mo to 24 mo)
Growth arrest of affected limb

11/17/2024 12
Ipsilateral upper limb flexion and
equinovarus deformity/circumduction of
the leg.
Unilateral UMN signs
Associated epilepsy (1/3), Intellectual
disability (25%)
MRI shows Causes viz: focal cerebral
infarcts (stroke), brain malformations
(porencephaly, lissencephaly)

11/17/2024 13
SPASTIC DIPLEGIC CP
 Accounts for 35% of CP
Clinical features:
 Bilateral spasticity of the lower limbs more than
the upper limbs
 Crawls with hands and drags feet (Commando
crawl)
 Difficulty wearing diaper due to adductor
hypertonicity
 Delayed walk
 Bilateral growth arrest of legs and disuse atrophy

11/17/2024 14
Bilateral UMN signs in the lower limbs
Scissoring posture when child is suspended
by the axillae
Learning disabilities and seizures are
common
MRI shows: PVL and ventricular dilation as
occurs in Prematurity

11/17/2024 15
SPASTIC QUADRIPLEGIC CP
Clinical features:
Most severe form of CP
Spasticity involving all limbs
Associated epilepsy and Intellectual disability
Swallowing difficulty (due to Pseudobulbar
palsy) with risk for aspiration pneumonia

11/17/2024 16
Decreased spontaneous movement
Associated speech and visual
abnormalities
MRI shows: Severe PVL, Multicystic
cortical encephalomalacia. Perinatal
Asphyxia is a known cause

11/17/2024 17
EXTRAPYRAMIDAL CP
Is less common (15 – 20% of CP)
Clinical Features:
Hypotonia is the main feature
Poor head control
Obvious head lag
Variable increased tone develops later
Feeding difficulties
Tongue thrust
Drooling of Saliva

11/17/2024 18
Speech abnormalities (oropharyngeal
muscle involvement)
UMN signs are absent
Seizures are less common
Intellect generally preserved
MRI: Lesions in basal ganglia and
Thalamus. Perinatal Asphyxia and
Kernicterus are known causes.

11/17/2024 19
CLINICAL EVALUATION
 HISTORY:
 Complaints usually a delay in attaining
developmental milestones
 Detailed pregnancy history (maternal acute
illness, illicit drug and alcohol use/abuse,
maternal DM, frequent early trimester
spontaneous abortions, infections)
 Perinatal history: gestational age at birth,
degree of prematurity, presentation of child and
delivery type, APGAR scores, birth weight,
neonatal infections, hyperbilirubinaemia

11/17/2024 20
Developmental history:
Gross motor skills
Fine motor skills
Communication/Language skills
Cognitive skills (including academic
performance)
Social skills

11/17/2024 21
Examination findings depend on the
type of CP.

11/17/2024 22
NEUROIMAGING
Cranial USS: At early neonatal period to
show intraventricular haemorrhage and
hypoxic-ischaemic injury
Brain CT Scan: imaging of blood,
calcifications and bone
Brain MRI: Diagnostic imaging of choice.
Defines cortical and white matter
structures better.

11/17/2024 23
TREATMENT
MULTIDISCIPLINARY APPROACH:
Paediatric neurologist
Occupational and physical therapist
Speech therapist
Social workers
Orthopaedic Surgeon
Developmental Psychologist

11/17/2024 24
MEDICAL:
Anticonvulsants (oral Diazepam)
Muscle relaxants (Baclofen,
Dantrolene)
Anti-cholinergics (Artane)
Reserpine
Botulinum toxin

11/17/2024 25
SURGICAL
Achilles tendon tenotomy, Constraint-
induced movement therapy -
constraining movement of the good
side with casts in order to exercise the
affected side (Spastic hemiplegic CP)
Adductor tenotomy, Psoas release,
Dorsal Rhizotomy (Spastic Diplegic)
Intrathecal baclofen pump insertion

11/17/2024 26
OTHER SUPPORTIVE MEASURES:
Standing frames
Walkers
Poles
Motorised wheelchairs
Special feeding devices
Talking typewriters
Bliss Symbols

11/17/2024 27
SPECIFIC APPROACH TO PREVENTION
Use of IV Magnesium Sulphate in
Pregnant mothers having preterm
labour contractions before 32 weeks
gestation
Therapeutic hypothermia (33.3o
C)

11/17/2024 28
COMPLICATIONS
Decubitus ulcer
Orthopaedic Complications: Hip dislocation,
contractures, scoliosis, osteoporosis
Feeding Problems: FTT, Obesity, Aspiration
Pneumonia, Dental caries, Malocclusion
Other associations: Epilepsy, Intellectual
disability, Strabismus, hearing loss (as in Acute
Bilirubin Encephalopathy), learning
disabilities)

11/17/2024 29
PROGNOSIS
Depends on the type of CP, the
aetiology, the severity and associated
developmental abnormalities and
complications.

CEREBRAL PALSY for mbbs student 500l classs

More Related Content

Similar to CEREBRAL PALSY for mbbs student 500l classs

More from Igbashio

Recently uploaded

CEREBRAL PALSY for mbbs student 500l classs