CEREBRAL PALSY Definition & Epidemiology - PowerPoint Presentation

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CEREBRAL

PALSY

Definition & Epidemiology

A group of

non progressive

disorders of movement and posture caused by

abnormal development

or

damage

to parts of brain that control muscle movements.

Prevalence

2-2.5/1000 live birth

Its more common in

Prematures

and twins

Risk factors

Prenatal & Perinatal

Low socioeconomic situation

Prematurity

IUGR/VLBW

Maternal

seizure disordersHormone Therapy :Thyroid- Estrogen or progesteronePregnancy complicationsMaternal FeverHyperbilirubinemiaAsphyxiaCongenital malformationsAcquired(post neonatal) (10%)MeningitisHead TraumaStroke

50% of CPs have-not any detectable risk factor

Diagnosis

Children with CP usually present with delay in reaching early developmental milestones and diagnosed

up to 18 month

by

Asymmetric movement

Spasticity

HypotoniaSometimes there are many co morbidities as:SeizureLearning disordersBehavioral disordersSensory disorders

Classification of CP based on Type of disability

Spastic

:

The most common type (70-80%)-Upper

motor pyramidal-At least two of these:

Abnormal movement pattern Hyper tonicity Pathologic reflexesDyskinetic: 10-15% of Cases - Abnormal motor pattern+ uncontrolled and repetitive motionAtaxic:Less than 5%-Cerebelluar injury-abnormal posture-movement nad or muscular disproportion

Dystonic:

Hypokinesia

-Hypotonia

Chorea-

Atetoide

:

Hyperkinesia

-Hypotonia

Mixed:

10-15% cases-Complications

are more common as sensory involvement-Seizure-

Classification of CP based on

anatomic involvement

Hemiplegia

Diplegia

: More severe in lower extremities

Quadriplegia:

Lower and upper extremities

Therapy

Physiotherapy

Botolinum Toxin

Baclofen pomp

(intratechal)

Anticonvulsants

……

Floppy baby

The Floppy infants Presenting features

Hypotonia

Posture(Frog leg)

Range of motion

Diminished resistant to passive movement

(Scarf sign-Pull to sit)

Delayed in Motor milestones

Diagnostic Studies

Perform complete Physical examination

Upper motor neuron lesion

Lower motor neuron lesion

Undescending

testis-High arc palate- Hypo mobility in uterine

Head CT Head MRI Electromyogram (EMG) Nerve Conduction Studies Look for Sepsis

Causes of Floppy Infant Syndrome

Central nervous system

Perinatal asphyxia

Encephalopathy

Kernicterus

Cerebral palsy (atonic type)

Intracranial hemorrhageChromosomal anomalies Inborn errors of metabolismSpinal cord lesionsAnterior horn cell disease werdnig HoffmanPoliomyelitisPeripheral nervousAcute polyneuropathy

Familial

dysautonomia

Congenital sensory neuropathy

Myoneural

junction

Neonatal myasthenia gravis

Infantile botulism

Following antibiotic therapy.

Causes of Floppy Infant Syndrome(

Cnt)

Muscles

Muscular dystrophies

Congenital

myotonic

dystrophiesCongenital myopathies PolymyositisGlycogen storage disease Arthrogryposis multiplex congenitalMiscellaneous Protein energy malnutritionRicketsPrader willi syndrome

Malabsorption

syndromes

Ehler-Danlos

syndrome

Cutis

laxa

Cretinism

Classification

Hypotonia with weakness

Neuromuscular disorders

Hypotonia without weakness

CNS

Metabolic

Chromosomal

Differentiating Features of a Floppy Infant according to Site of Involvement

Site of involvement

Extent to weakness

Proximal vs. distal weakness

Face

Arms

Legs

Central

-

+

+

> or =

Anterior horn cell

+

++++

++++

> or =

Peripheral nerve

-

+++

+++

<

Neuromuscular

junction

+++

+++

+++

=

Muscles

Variable

++

+

>

Differentiating Features of a Floppy Infant according to Site of Involvement

(Contd.)

Site of involvement

Deep tendon reflexes

EMG

Muscle biopsy

Central

Normal or increased

Normal

Normal

Anterior horn cell

Absent

Fasciculation / fibrillation

Denervation

pattern

Peripheral nerve

Decreased

Fibrillation

Denervation

pattern

Neuromuscular junction

Normal

Decremental / incremental

Normal

Muscle

Decreased

Short duration small amplitude potential

Characteristic

Diagnostic Studies

Labs: initial

Serum electrolytes

Serum Calcium

Serum Glucose

Creatine

Phosphokinase (CPK) Toxic scanBlood Culture Lumbar Puncture with Cerebrospinal Fluid Examination Thyroid Function TestsLabs: Test as indicated Toxicology screen Serum Ammonia and Venous pH Serum amino acids Urine amino acids and organic acid Karyotype

TORCH Virus Screening

Neurology Chapter of IAP

Neurology Chapter of IAP