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Updated: Jan 28 2021

Cerebral Palsy

  • Snapshot
    • A 14-month-old male is brought to the pediatrician because he is not able to walk. His mother is very concerned because her friend's daughter began walking around 12 months of age. He was born at 30 weeks gestation to his 28-year-old G1P1 mother. The pregnancy was complicated by eclampsia requiring emergency Cesarean delivery. The mother also reports her son has difficulty with swallowing. Physical exam is notable for hypertonic muscle tone, absence of selective motor control, and motor delay.
  • Introduction
    • Nonprogressive, persistent, central nervous system disorder
      • characterized by abnormalities in muscle tone, movement, posture
        • secondary to brain injury during the prenatal and perinatal period
        • signs and symptoms may not be revealing at birth and may require time before symptoms become apparent
      • may be accompanied by various comorbidities
        • pain
        • intellectual/learning disability
        • seizures
        • visual impairment
    • Risk factors are multifactorial, and include:
      • prematurity (most common)
        • patients can have cerebral palsy even when born at term
        • prematurity puts neonate at risk for intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia
          • increases the risk of developing cerebral palsy
      • intrauterine infections
      • perinatal stroke
      • intrauterine growth restriction
    • There are spastic, dyskinetic, ataxic forms of cerebral palsy
      • may suggest cause of cerebral palsy
  • Presentation
    • Evidence of motor milestone delay
    • Delay in the disappearance, or exaggeration of primitive reflexes
    • Motor tone and posture abnormalities
  • Evaluation
    • This is a clinical diagnosis
      • requires a thorough history and physical examination
    • MRI
      • is obtained in
        • all children with cerebral palsy when the etiology has not been made
      • should also be obtained when
        • there is a change from the expected clinical course or if there are findings concerning for an alternative diagnosis
    • EEG in patients with cerebral palsy and possible seizure activity
  • Treatment
    • Multidisciplinary care team
      • e.g., pediatric neurologists, orthopedic surgeons, phyiscal, educational, speech therapists, etc.
    • Pain management
    • Improving spasticity
      • e.g., baclofen, diazepam, dorsal rhizotomy
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