Neurology · MU Sofia

81. Cerebral palsy

Explains cerebral palsy as a permanent, non-progressive disorder of movement and posture arising from early brain injury. Covers prenatal, perinatal and postnatal causes, the brain regions involved, and the four types: spastic, dyskinetic, ataxic and mixed, with their features. Also outlines clinical features, examination findings, diagnosis with differentials, and multidisciplinary treatment including spasticity management.

Inside: 1 section · 2 labelled pictures · 15 flashcards · 2 min

Topic 81 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 307 words (2 min of reading), with 15 flashcards.

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  1. Cerebral palsy

Cerebral palsy

Definition: Cerebral Palsy is a group of permanent, non-progressive disorders of movement and posture caused by injury or abnormal development of the immature fetal or infant brain.

➡️ Brain lesion is non-progressive, but clinical manifestations may change with growth.

Etiology

1.Prenatal Causes (Most Common): Prematurity. Intrauterine infections (TORCH). Genetic abnormalities.Maternal illness

2.Perinatal Causes: Birth asphyxia (hypoxic-ischemic injury). Premature birth. Intracranial hemorrhage

3.Postnatal Causes: Meningitis/encephalitis. Head trauma. Severe neonatal jaundice (kernicterus)

Pathogenesis

Damage to: Motor cortex. Corticospinal tracts. Basal ganglia. Cerebellum

➡️ Leads to abnormal muscle tone, posture, and movement.

Classification

1. Spastic CP (Most Common, ~70–80%): Pyramidal tract involvement

  • Types: Spastic hemiplegia. Spastic diplegia (legs > arms; common in prematurity). Spastic quadriplegia
  • Features: Hypertonia. Hyperreflexia. Babinski sign. Scissoring gait

2. Dyskinetic (Athetoid) CP: Basal ganglia involvement

  • Features: Chorea. Athetosis. Dystonia. Fluctuating muscle tone

3. Ataxic CP: Cerebellar involvement

  • Features: Ataxic gait. Intention tremor. Poor coordination

4. Mixed CP: Combination of different types.

Clinical Features

  • Motor Symptoms: Delayed motor milestones. Abnormal posture. Muscle weakness. Abnormal gait
  • Tone Abnormalities: Spasticity (most common). Rigidity. Hypotonia (early infancy)
  • Associated Disorders: Intellectual disability. Epilepsy. Visual impairment. Hearing impairment. Speech disorders. Learning difficulties

Examination Findings

  • Spastic CP: Increased tone. Hyperreflexia. Clonus. Positive Babinski sign
  • Developmental Assessment: Delayed sitting, standing, walking. Persistent primitive reflexes

Diagnosis

  • Clinical Diagnosis: Delayed motor development. Persistent neurological deficits. Non-progressive course
  • MRI Brain
  • May show: Periventricular leukomalacia (premature infants). Cortical malformations. Hypoxic-ischemic injury
  • Additional Tests: Hearing assessment. Vision assessment. Developmental evaluation

Differential Diagnosis

1. Muscular Dystrophy: Progressive weakness. Elevated CK

2. Spinal Muscular Atrophy: LMN signs. Fasciculations

3. Metabolic/Genetic Disorders: Progressive deterioration

4. Neurodegenerative Diseases: Progressive neurological decline

Treatment

Multidisciplinary Management

  • Rehabilitation: Physiotherapy (most important). Occupational therapy. Speech therapy
  • Spasticity Management: Baclofen. Botulinum toxin injections. Orthopedic interventions
  • Associated Conditions: Antiepileptic drugs (for seizures). Visual/hearing support

Prognosis: Depends on severity. Non-progressive brain lesion. Life expectancy varies according to disability and complications

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