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CP 10
CP 10
Weakness
Neurology Module
Pediatrics II
Cerebral Palsy - Objectives
At the end of this topic you should be able to:
provide a clear definition of cerebral palsy;
discuss aetiological and risk factors
associated with cerebral palsy;
explain the clinical features and associated
impairments common to cerebral palsy;
demonstrate an understanding of diagnostic
methods;
recognize the various methods of effectively
managing cerebral palsy.
The Child with a Motor Weakness
2 yr. old F
Asphyxia in the newborn period
Delayed motor development
Delayed language development
Rt hemiparesis
Hyperreflexia (Rt)
Babinski (Rt)000
QUESTION #1: Is there a
neurologic disease?
Yes, as evidenced by the abnormal
neurologic examination.
QUESTION #2: Where is the
lesion?
The abnormalities in the tone
(spasticity) and movement ( hemiparesis)
point to the motor system.
Weakness can be due to lesions in the :
1. Central nervous system – Upper motor neuron
(spasticity, hyperreflexia); may be accompanied by
cerebral manifestations (seizures, cognition,
language and sensory problems)
2. Peripheral nervous system – Lower motor neuron
(decreased to absent reflexes, flaccid)
QUESTION #2: Where is the
lesion?
C.R appears to have
an upper motor lesion
specifically the cerebral
hemispheres.
Spasticity is the opposite with
hyperextension of the limbs as in this
patient
QUESTION #3: What is the nature
of the lesion?
Disorders of the motor system may be:
1. Acute - strokes/vascular
metabolic disorders
infection
2. Chronic - cerebral palsy (static)
congenital CNS lesion
degenerative disorders
(progressive)
CEREBRAL PALSY
Refers to a group of disorders characterized by
motor abnormalities (tone, posture or
movement) which are neither progressive nor
episodic.
More
Affected
Less
Affected
Physiologic Classification
Hypotonic Cerebral
Palsy
Physiologic Classification
Spastic Diplegic
Cerebral Palsy
Diagnosis
1. Thorough history, developmental assessment,
physical and neurological examinations
2. Hearing and vision screening
3. EEG if with seizures
4. If no possible etiology or risk factors for CP,
may do diagnostic tests as:
Neuroimaging – CT/MRI
Metabolic screening
Chromosomal study
Differential Diagnosis
1. Motor delays from congenital structural
lesions
2. Progressive disorders of the brain –
white matter diseases
3. Muscle disorders- myopathies,
dystrophies.
Management
Multidisciplinary
1. Pediatrician
2. Neurologist
3. Rehabilitation specialists
4. Physical and occupational therapists
5. Developmental psychologists
6. Education specialists
7. Orthopedic surgeons
8. Social workers
Thank
you!