Cerbral palsy patho-physiology

Question 1

Periventricular White Matter (around the lateral ventricles)

Answer 1

*Main pathology in CP (especially spastic diplegia) — Damage to the periventricular white matter due to periventricular leukomalacia (PVL), commonly resulting from hypoxia-ischemia in premature infants.
*Relevant symptoms in Paula:
- Spasticity in both lower limbs (hypertonia, contractures in adductors, hamstrings, calves)
- Hip flexion, adduction, and medial rotation
- Difficulty with standing and walking (uses walking aids and wheelchair)
- Frequent fatigue when sitting or standing unaided

Question 2

Corticospinal Tracts (particularly affecting lower limbs)

Answer 2

*Pathology — Damage to motor tracts responsible for voluntary movement. In spastic diplegia, the lower limb portions of these tracts are more affected.
*Relevant symptoms in Paula:
- Weakness in lower limbs
- Reduced selective motor control (e.g. foot inversion, poor hip/knee/ankle coordination)
- Reliance on walking aids and wheelchair for mobility
- Fatigue during functional tasks like sitting or walking

Question 3

Basal Ganglia (indirectly affected in motor planning and tone regulation)

Answer 3

*Pathology — Although not directly damaged in all cases of CP, disrupted communication between the motor cortex and basal ganglia can contribute to increased muscle tone and poor coordination.
*Relevant symptoms in Paula:
- Ataxic movements in upper limbs (difficulty with accuracy while drawing or using cutlery)
- Involuntary overflow movements or tremor during fine motor tasks
- Coughing while eating/drinking — may reflect poor coordination of oromotor muscles (linked to impaired motor control)

Question 4

Cerebellum (motor coordination and balance)

Answer 4

*Pathology — CP may involve or affect cerebellar connections, leading to poor balance and coordination.
*Relevant symptoms in Paula:
- Poor trunk stability and control (can only sit unaided for ~15 minutes)
- Falls when walking; difficulty maintaining balance
- Avoidance of walking due to effort and instability

Question 5

Brainstem Nuclei (involved in swallowing and respiration)

Answer 5

*Pathology — Poor neuromuscular control due to disrupted motor pathways can affect cranial nerve nuclei, especially those involved in swallowing.
*Relevant symptoms in Paula:
- Coughing while drinking — possibly due to oropharyngeal dysphagia
- Embarrassment and distress during mealtimes (suggests impaired coordination of swallow reflex)