Cerebral palsy

Definition:
Permanent disorder of movement& posture result in non progressive brain lesion
Associated with:
 Epilepsy
 Impaired vision
 Impaired speech
 Impaired hearing
 Impaired feeding
 Difficult movement
 Mental retardation
 Behavioral disturbances
Postnatal:
Etiology:
 Asphyxia
Perinatal:
 VLBW+ICH
 Prenatal
 Meningitis
 Natal  Hydrocephalus
 Postnatal  Metabolic: RBS
Natal:
Prenatal:  Birth trauma  Metabolism: PKU
 Anomalies  Birth asphyxia
 Infection
 Asphyxia

Clinical picture:
History:
 When he appears abnormal?
 What are his problems?
 How he is doing now?
 Spastic
 Why he is unwell?
 Ataxic
Examination:
 Diplegia  Atonic
 Squint  Paraplegia  Mixed
 Seizures  Hemiplegia  Dyskinetic/Athetoid
 Scissoring  Monoplegia
 Disoriented  Quadriplegia
 Microcephaly

Conclusion: POSTER 4/6

 Position: spastic, frog leg
 Oro-pharyngeal: difficult swallowing

Dr. Noura Noraddin 2020 1

 Squint or nystagmus
 Tone: spastic or atonic
 Evolution of primitive reflexes: delayed
 Reflexes: hyper-reflexia
Differential diagnosis:
 Myopathy
 Familial spastic CP
 Sandifer syndrome
 Spinal cord disorder
 Ataxia Telangectasia
Investigations:
 Metabolism: pH, ammonia, organic acids, amino acids
 TORCH screening: Toxoplasama, Rubella, CMV& HS
 Brain C-T scan: anomalies, atrophy& degeneration
 Genetic evaluation: specific syndromes
 Ophthalmic consultation: fundus
 ENT consultation: ABR
 EEG: epilepsy
Management:
Team work
 Pediatrician
 Physiotherapy
 Speech therapy
 Ophthalmologist
 Otolaryngologist
 Occupational therapy
 Social workers& psychologist
Assessment& support:
 Vision& hearing aids
 Feeding& defecation aids
 Walking, standing& sitting aids
Medications:
 Muscle relaxants: baclofen, dantrolene& botox inj
 Antiepileptic drugs: phenobarbitone, clonazepam& levtiraceta
Surgery:
 Tenontomy
 Gastrostomy
 Squint correction

Dr. Noura Noraddin 2020 2