CEREBRAL PALSY / LITTLE’ DISEASE /

SPASTIC ENCEPHALOPATHY

DEFINITION

● Is a disorder of balance, coordination, movement, and posture as a result of

spatic damage to the developing brain.(Dr.uhms)

● Is due to permanent and non-progressive disturbances in the developing

fetal or infant brain leading to permanent and progressive disorder of
movement, tone and posture cause activity limitation plus with epilepsy,
cognitive dysfunction speech or visual or hearing impairment intellectual
and behavioral problems.(Learning pediatrics youtube)

● Is permanent and non-progressive damage in the fetal/infant brain with

permanent and progressive change in the motor symptoms.(Learning
pediatrics youtube )

ETIOLOGY

● Antenatal
● Perinatal and Natal
● Post-natal

Antenatal
● Neonate
● Congenital brain abnormality
● Cerebrovascular accident
● Multiple gestation
● TORCH infection
● Intrauterine growth restriction
● Placental abnormality
 ● Chromosome abnormalities

● Maternal
● Comorbidity
● Maternal infection
● Drug abuse
● Smoker
● Previous premature delivery
● Exposure to radiation/toxics
● Late bleeding: placenta previa. Placenta abruptio
● Preeclampsia

Perinatal and Natal

● Birth asphyxia
● Neonatal sepsis
● Permaturity
● Low birth weight
● Intraventricular/periventricular hemorrhage
● Meconium aspiration
● Seizure
● Birth trauma
● Persistent pulmonary hypertension

Post-natal
● Acute Head/ brain injury
● Shaken syndrome
● Meningitis/Encephalitis
● Kernicterus/ hyperbilirubinemia
● Stroke
● Toxins
● Infections
CLASSIFICATION OF CEREBRAL PALSY

● Anatomical
● Physiological
● Functional

Anatomical/ Topographical

Spastic form(Pyrimidal)
Is characterized by persistent primitive reflexes positive babinski reflexes,
ankle clonus, exaggerated stretch reflexes and eventual development of
contracture

● Diplegia: all limbs affected lower limbs more affected than upper
limbs

● Hemiplegia: motor dysfunction on one side of the body. Upper limbs

more affected than lower limbs

● Quadriplegia: all four limbs affected.

● Triplegia: involves three extremities. Both lower limbs and one upper
limb

● Monoplegia: involves only one extremities

● Paraplegia: pure cerebral paraplegia of the lower limbs. Both lower

limbs affected

Physiological

1. Pyramidal involvement
 ● Spastic: pyramidal lesion from the high senses to the anterior motor horn

2. Extrapyramidal involvement
● Dyskinetic: due to scars in the basal ganglia-putamen, globus, pallidus,
thalamus or hippocampus

● Ataxic: due to lesion in the the cerebellum

● Atonic/Hypotonic: due to extensive brain damage

● Mixed: due to extensive brain damage

3. Functional
● Grade I
● Grade II
● Grade III
● Grade IV

PATHOGENESIS

Intrauterine/peripartum asphyxia
⇓
Fetal acidosis and hypoxia
⇓
Intracellular edema
⇓
Cerebral tissue pressure increase
⇓
Cerebral flow to decrease
⇓
Cerebral edema and necrosis
⇓
Cerebral tissues collapse and involutes
⇓
 Nodular sclerotic microgyria

CLINICAL FEATURES/MANIFESTATION

● EARLY SIGNS
● Persistent primitive reflexes
● Excessive lethargy
● Poor head control
● Stiff and floppy posture
● Tongue thrust
● Irritability/ high pitched cry
● Delay development
● Abnormal muscle tone/posture
● Drags feet-like/ commando sign/ toe walking
● Seizure
● Difficulty toilet care

● Soft neurological signs

● Head bobbing
● Foot tapping
● Finger agnosia
● Strabismus
● Verbal dyspraxia
● Choreoathetoid movement
● Attention deficit

Features according to types

DIAGNOSES

● History taking and clinical presentation

● Physical examination
● Diagnostic
● Laboratory
● Supportive test

Diagnostic
● MRI
● CT scan
● Ultrasonography cranium( done 3rd, 7th and 30th day of life)
● Electroencephalogram
● Electromyogram

Laboratory
● Genetic screen
● Clotting profile
●
Supportive test
● Visual assessment
● Hearing assessment
● Speech assessment
● Development and intelligent quotient

COMPLICATION

● Spasticity
● Weakness
● Increase reflexes
● Clonus
● Seizures
● Articulation & Swallowing difficulty
 ● Visual compromise
● Deformation
● Hip dislocation
● Kyphoscoliosis
● Constipation
● Urinary tract infection

MANAGEMENT

It is a multidisciplinary approach of treatment

● Pharmacological
● Rehabilitation therapy:
● Physiotherapy
● Speech therapy
● Occupational therapy
● Education therapy
● Surgical
● Neurectomy
● Neurolysis
● Selective dorsal rhizotomy
● Osteotomy
● Supportive
● Assisted adaptive equipment
● Special care

DR.AKAPIRE