Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies (CP) refers to a group of conditions resulting in motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology impairment affecting tone and posture and limiting physical activity. Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies is the most common cause of childhood disability Disability Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for social security and workman's compensation benefits. ABCDE Assessment. It is caused by a nonprogressive CNS injury to the fetal or infant brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification. It is classified according to muscle tone Muscle tone The state of activity or tension of a muscle beyond that related to its physical properties, that is, its active resistance to stretch. In skeletal muscle, tonus is dependent upon efferent innervation. Skeletal Muscle Contraction, its distribution, and the presumed time of injury (spastic diplegia is the most common), and it is present in around 3 per 1,000 live births. Diagnosis is made by a detailed history and physical exam with an MRI scan confirming CNS insult. Interventions are multidisciplinary and prognosis Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas depends on the degree of disability Disability Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for social security and workman's compensation benefits. ABCDE Assessment.
Last updated: 25 Oct, 2021
Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies (CP) is a syndrome of permanent motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology impairment (posture and movement) that results from nonprogressive lesions to the developing brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification.
The ultimate cause of CP is injury to a child’s CNS during its embryological or perinatal development. The pathophysiology of this insult varies based on its etiology.
CP subtype | Etiologies | MRI findings |
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Hemiplegia (25%) |
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Spastic quadriplegia Quadriplegia Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending corticospinal and corticobulbar tracts. Locked-in Syndrome (20%) |
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Spastic diplegia (35%) |
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Extrapyramidal (athetoid, dyskinetic) (15%) |
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Neurological:
Photograph of a child with spastic diplegia:
Notice the scissoring of the legs, a key finding in the spastic diplegic form of cerebral
palsy
Palsy
paralysis of an area of the body, thus incapable of voluntary movement
Cranial Nerve Palsies (CP).
Different types of structural
brain
Brain
The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.
Nervous System: Anatomy, Structure, and Classification abnormalities in cerebral
palsy
Palsy
paralysis of an area of the body, thus incapable of voluntary movement
Cranial Nerve Palsies (CP):
All images are
axial
Axial
Computed Tomography (CT) T2-weighted MRI scans. Each image is subtitled by its presumed etiology and timing during gestation.
A: a child with lissencephaly showing cortical thickening and agyria
B: a child with
congenital
Congenital
Chorioretinitis
cytomegalovirus
Cytomegalovirus
CMV is a ubiquitous double-stranded DNA virus belonging to the Herpesviridae family. CMV infections can be transmitted in bodily fluids, such as blood, saliva, urine, semen, and breast milk. The initial infection is usually asymptomatic in the immunocompetent host, or it can present with symptoms of mononucleosis.
Cytomegalovirus infection showing an overfolded cortex (polymicrogyria), thin
white matter
White Matter
The region of central nervous system that appears lighter in color than the other type, gray matter. It mainly consists of myelinated nerve fibers and contains few neuronal cell bodies or dendrites.
Brown-Séquard Syndrome, and dilated
lateral ventricles
Lateral ventricles
Cavity in each of the cerebral hemispheres derived from the cavity of the embryonic neural tube. They are separated from each other by the septum pellucidum, and each communicates with the third ventricle by the foramen of monro, through which also the choroid plexuses (choroid plexus) of the lateral ventricles become continuous with that of the third ventricle.
Ventricular System: Anatomy
C: an ex-
premature
Premature
Childbirth before 37 weeks of pregnancy (259 days from the first day of the mother’s last menstrual period, or 245 days after fertilization).
Necrotizing Enterocolitis child showing
cystic
Cystic
Fibrocystic Change
white matter
White Matter
The region of central nervous system that appears lighter in color than the other type, gray matter. It mainly consists of myelinated nerve fibers and contains few neuronal cell bodies or dendrites.
Brown-Séquard Syndrome injury (arrows) consistent with periventricular leukomalacia
D: a child who suffered a
hemorrhagic stroke
Hemorrhagic stroke
Stroke due to rupture of a weakened blood vessel in the brain (e.g., cerebral hemispheres; cerebellum; subarachnoid space).
Subarachnoid Hemorrhage in the
newborn
Newborn
An infant during the first 28 days after birth.
Physical Examination of the Newborn period. There is cortical and
white matter
White Matter
The region of central nervous system that appears lighter in color than the other type, gray matter. It mainly consists of myelinated nerve fibers and contains few neuronal cell bodies or dendrites.
Brown-Séquard Syndrome loss in the right
frontal
Frontal
The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face.
Skull: Anatomy and
parietal
Parietal
One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium.
Skull: Anatomy lobes (arrowheads) consistent with previous
ischemia
Ischemia
A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation.
Ischemic Cell Damage.
GMFCS level | Characteristics |
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I |
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II |
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III |
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IV |
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V |
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There is no curative treatment at this time. Management focuses on improving symptoms and increasing function while addressing comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus. Early multidisciplinary intervention improves patient outcomes.
The following conditions are etiological and/or risk factors for CP: