Definition: Cerebral
palsy is a static encephalopathy that causes disordered movement and posture.
Incidence: Moderate to
severe cerebral palsy is estimated to affect 1.5 to 2.5 per 1000 people born in
the United States. Premature babies are at higher risk. The rates of cerebral
palsy per live births have been rising. One possibility for the increased rate
of this disease is the increased survival of children with very low birth
weights.
Age:
The brain abnormalities may be prenatal,
perinatal, or postnatal. Cerebral palsy is usually diagnosed at approximately 1
year of age.
Race: Cerebral
palsy affects all races.
Etiology: Cerebral
palsy has many prenatal, perinatal, and postnatal causes. The causes may be due
to trauma, toxins, radiation, infections, genetics, vascular insufficiency, or
anoxia. Several causes often contribute to the development of cerebral palsy.
Clinical Presentation: There are
several common presentations of cerebral palsy. Spastic hemiplegia affects one
side of the body more than the other and frequently includes learning disabilities
and seizures. Spastic diplegia mostly affects the lower extremities. Dyskinesia
mostly affects the upper extremities. Spastic quadriplegia affects all of the
limbs and is associated with many medical complications. Clinical signs of
cerebral palsy include an asymmetrical posture or gait, abnormal coordination,
growth disturbances, and abnormal muscle tone. Patients may be either hypotonic
or hypertonic with joint contractures due to spastic muscles. The hip is often flexed
and adducted. The knee is often flexed and extended. Both the knee and the
hindfoot may be in varus or valgus. Patients with cerebral palsy often retain
primitive reflexes that are normally lost during normal development.
Pathology: In cerebral
palsy, the muscles have shortened muscle fibers and the brain has defects or
lesions.
Diagnostic Procedures: Neuroimaging
studies are useful in determining brain damage. Neonatal sonography, magnetic resonance
imaging, and computed tomography may all be used to check for white matter
disease, periventricular leukomalacia, injury, hemorrhage, and malformation.
Laboratory studies are also useful, and endpoints include lactate and pyruvate levels,
thyroid functioning, amino acids, cerebrospinal protein, and chromosome
studies.
Treatment: Several
surgical interventions can treat cerebral palsy. Spastic muscles may be treated
by tendon lengthening, or posterior rhizotomy, which treats velocity dependent
spasticity, or an intrathecal baclofen pump, which targets the lower extremities.
Hip dislocations, most often posterior, may be treated with hip relocation
surgery. Furthermore, scoliosis repair and/or an osteotomy may be necessary.
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