Neuro 2 - Martin - Cerebral Palsy

Front 1

Define Cerebral Palsy

Back 1

Motor symptoms resulting from Dysfunction in early brain development

Front 2

Is cerebral palsy static or changing?

Back 2

static = doesn't change, BUT as the CNS matures, the original lesion does not change

Front 3

T/F: Perinatal difficulties are associated with but NOT THE CAUSE of cerebral palsy (80%)

Back 3

TRUE

Front 4

T/F: maternal infection or low birth weight significantly increases risk of Cerebral palsy

Back 4

TRUE

Front 5

T/F: inc. cerebral palsy risk: maternal infection, very low birth weight infants

Back 5

TRUE

Front 6

Why are very low birth weight infants at inc. risk for cerebral palsy?

Back 6

They are more at risk of Intracranial hemmorhage and very high risk of periventricular Leukomalacia

AND immature oligodendroglia are vulnerable to oxidative damage (from stress, ischemia, infection, inflamm)

Front 7

T/F: Many pts with Cerebral palsy function at normal educational and vocational levels

Back 7

TRUE

Front 8

List the 4 types of Cerebral palsy

Back 8

Spastic Diplegia, Hemiplegia, Spastic Quadriplegia, Extrapyramidal

Front 9

define Spasticity

Back 9

Muscles are high in tone with resistance to stretch but weak in strength

Front 10

Define Athetosis

Back 10

Slow, writhing, continuous, involuntary movements, most noticable when pt moves purposefully

Front 11

Define Ataxia

Back 11

unsteady, shaky movements or tremor

Front 12

Bilaterally spasticity of LEGS GREATER THAN arms such as brisk LE reflexes, ankle clonus (involuntary contractions), Bilateral Babinski sign. DX?

Back 12

Spastic Diplegia

Front 13

Baby scissors legs when held upright, commando crawls, and has massive hip Adduction. Dx?

Back 13

Spastic Diplegia

Front 14

Pt has Bilaterally spasticity of LEGS GREATER THAN arms such as brisk LE reflexes, ankle clonus (involuntary contractions), Bilateral Babinski sign. What do we do to Dx?

Back 14

Think Spastic Diplegia

Get MRI to see if there is periventricular leukomalacia (PVL) in area where fibers innervating legs course through internal capsule

Front 15

Whats the MOST SEVERE form of Cerebral palsy?

Back 15

Spastic Quadriplegia

Front 16

Pt has Marked motor impairment in all 4 extremities. What can you tell the parents they can expect as associated symptoms?

Back 16

Think Spastic Quadriplegia

Seizures, MR, swallowing dysfunction

Maybe: speech and visual abnormalities

Front 17

What lesions will we see in MRI with Spastic Quadriplegia?

Back 17

Severe periventricular leukomalacia

Front 18

Pt has dec spontaneous movement in all 4 limbs, babinski, and brisk reflexes in all 4 limbs. Dx?

Back 18

Spastic quadriplegia

Front 19

Pt has RIGHT Arm reflex brisk and RIGHT LEG reflex brisk. Circumductive gait (AKA hemiplegia gait), Inulateral ankle clonus on RIGHT, and babinski on right. Dx?

Back 19

Spastic Hemiplegia

Front 20

T/F: pts are less likely to have cognitive abnormalities than to have cognitive abnormalities with Cerebral palsy

Back 20

TRUE

Front 21

Pt has Pt has RIGHT Arm reflex brisk and RIGHT LEG reflex brisk. Circumductive gait (AKA hemiplegia gait), Inulateral ankle clonus on RIGHT, and babinski on right. Where will we see the LESION on MRI? whats the usual cause

Back 21

think spastic hemiplegia

Lesion will be on opposite side from problems, so LEFT

Usual cause = infarction in utero or neonatally (OR thrombophilic disorder, or infection)

Front 22

Infant combs out of womb with head hanging down, normal intellect, and can't suckle (oropharyngeal muscles affected). Dx?

Back 22

Extrapyramidal Cerebral Palsy

Front 23

Infant combs out of womb with head hanging down, normal intellect, and can't suckle/is drooling/tongue thrusting (oropharyngeal muscles affected). What can we tell the parents to expect as the child grows older?

Back 23

Think Extrapyramidal Cerebral palsy

As they grow older they'll develop variable tone with rigidity and dystonia

Front 24

baby was void of oxygen for a while during birth. What type of cerebral palsy is most likely?

Back 24

Extrapyramidal

Front 25

Infant combs out of womb with head hanging down, normal intellect, and can't suckle (oropharyngeal muscles affected). Where do we expect to see the lesion?

Back 25

Think Extrapyramidal

Lesion most comonly associated with asphyxiation is bilaterally in the posterior putamen and ventrolateral thalamus

Front 26

An infants Extrapyramidal cerebral palsy is determined to be caused by Kernicterus (bilirubin-induced brain dysfunction). Where is the lesion?

Back 26

Globus Pallidus bilaterally

Front 27

How do we dx cerebral palsy?

Back 27

History of a STABLE (NON-PROGRESSING) disorder with MRI of brain showing location of lesion

Front 28

BEST treatment for cerebral palsy?

Back 28

PREVENTION

Prenatal care a MUST

Front 29

If you are unable to prevent cerebral palsy, what other steps can you take to treat them?

Back 29

Supportive family = parents taught how to care for baby ie how to dec. muscle contractures, how to feed, dress, bath, etc

Physical therapy
Walkers, Poles/crutches/standers/computers/bliss symbols

OMT!!!!!!!!!!!!!!! (trials ongoing)