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CEREBRAL PALSY

Dr. Nelly A. Risan, Sp.A


Pediatric Neurology Subdivision
Pediatric Department
Hasan Sadikin General Hospital

DEFINITION

Cerebral palsy (CP) is a diagnostic term


used to describe a group of motor
syndromes resulting from disorders of
early brain development
CP is caused by a broad group of
developmental, genetics, ischemic,
infectious and other acquired etiologies
produced a common group of neurologic
phenotypes

Static

encephalopathy has historically


been considered but it is now inaccurate
because neurologic features of CP often
change over time
CP often associated with epilepsy,
abnormalities of development (speech,
vision, cognitive), it is the selective
vulnerability of the brains motor system
Many children with CP function at a high
educational / vocational level

Epidemiology and Etiology


CP

is the most common and costly form of


chronic motor disability that begins in
childhood
Prevalence : 2 / 1.000
80% of cases features were identified to
antenatal factors causing abnormal brain
development
Less then 10% had evident of intrapartum
asphyxia

Epidemiology and Etiology


Intrauterine

exposure to maternal infection


is associated with significant increase in
the risk of CP in normal birth weight
infants
The prevalence of CP is increased among
low birth weight infants, particularly less
than 1.000 gram at birth, primarily
because of periventricular hemorrhage
(PVL)

Epidemiology and Etiology


PVL (Periventricular

leukomalacia)
remains a major problem reflect the
enhanced vulnerability of immature brain
to oxidative stress caused by ischemia

CLINICAL MANIFESTATION
CP

is generally divided into several major


motor syndromes that diver according to
the pattern of neurological involvement,
neuropathology and etiology

Classification of CP
Motor
Syndromes

Neuropathology

Major causes

Spastic diplegia

PVL

Prematurity
Ischemia
Infection
Endocrine/metabolics (e.g.
thyroid)

Spastic
quadriplegia

PVL
Multicystic
encephalomalacia
Malformations

Ischemia
Infection
Endocrine/metabolics (e.g.
thyroid)
Genetic/developmental

Classification of CP
Motor
Syndromes

Neuropathology

Major causes

Hemiplegia

Stroke: in utero or
neonatal

Trombophilic disorder
Infection
Genetic/developmental
Periventricular hemorhage
infarction
Asphyxia

Extrapyramidal
(athetoid,
dyskinetic)

Basal ganglia
Pathology: putamen,
globus pallidus,
thalamus

Kernicterus
Mitochondrial
Genetic/metabolic

CLINICAL MANIFESTATION
Spastic

hemiplegy:

Decreased spontaneous movement on


affected sites and show hand preference at
very early age
Arm often more involved than the leg
Spasticity is apparent particularly the ankle
causing equinovarus deformity of the foot
walk on tip toes because of increased tones
Upper extremity assumed dystonic posture
Ankle clonus and Babinsky sign may be
present
The tendon reflexes

CLINICAL MANIFESTATION
Spastic

diplegy:

Bilateral spasticity of the legs > arms


When the child is suspended by the axillae
scissoring posture of the lower extremities
Walking significantly delayed

CLINICAL MANIFESTATION
Spastic

quadriplegy:

The most severe form of CP because of


marked motor impairment of all extremities
and the high association with MR
Swallowing difficulties are common as a
result of supranuclear bulbar palsies

CLINICAL MANIFESTATION
Athetoid

CP / Extrapiramidal CP:

Less common than spastic CP


Characteristically hypotonic with poor head
control and marked head lag and develop
increased variable tone with rigidity and
dystonia over several years
Feeding may be difficult and drooling may
be prominent
Speech is typically affected because of
oropharygeal muscle are involved

DIAGNOSIS
A

thorough history and physical exams


should preclude a progressive disorders of
the CNS
MRI Scan of the brain is a generally
indicated to determine the location and
extent of structural lesions
Genetic evaluation should be considered
in patients with congenital malformations
Multidisciplinary approach is most helpful
in the assessment

TREATMENT
A

team of physicians from various


specialties as well as occupational,
physical therapist, speech pathologist,
social workers, educators and
psychologist provide important
contributions
Parents should be taught to handle in daily
activities (feeding, bathing, etc)

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