Cerebral palsy and hypoxic-ischaemic encephalopathy

Question 1

Cerebral palsy can be defined as a movement disorder, where damage to the brain causes a palsy of some kind. What is the incidence of this?

1 - 200-350 per 1,000 live births
2 - 20-35 per 1,000 live births.
3 - 2-3.5 per 1,000 live births.
4 - 0.2-0.35 per 1,000 live births.

Answer 1

3 - 2-3.5 per 1,000 live births

Most common cause of motor impairment

This is in resource rich countries, likely to be higher in poorer countries due safe antenatal and perinatal care, and poorer nutrition

Question 2

Do the majority of cerebral palsies occur before or after birth?

Answer 2

• before birth

Categorised as a neurodevelopment condition, where part of the cerebrum does not develop correctly

Question 3

All of the following are causes of prenatal (before birth) cerebral palsy, EXCEPT which one?

1 - infection
2 - head trauma
3 - hypoxia of babies brain
4 - radiation exposure

Answer 3

2 - head trauma

Not common pre-natally, but can occur postnatally.

Question 4

All of the following are causes of postnatal (before birth) cerebral palsy, EXCEPT which one?

1 - infection
2 - head trauma
3 - hypoxia of babies brain
4 - radiation exposure

Answer 4

4 - radiation exposure

Not common
Typically occurs prenatally

Question 5

Are there genetic causes of cerebral palsy?

Answer 5

• yes

Question 6

Is cerebral palsy considered as a progressive condition?

Answer 6

• no

Patients typically do NOT deteriorate

Question 7

Do patients with cerebral palsy typically have hypo or hypertonia?

Answer 7

• hypertonia

Often described as stiff or spastic, making movements appear jerky

Question 8

There are different classifications of cerebral palsy based on the type of muscle movement that result from the damage to the brain. Which of the following accounts for 70% of cerebral palsy cases?

1 - spastic
2 - dyskinetic
3 - ataxic
4 - mixed

Answer 8

1 - spastic

Can be:
- hemiplegic = one side of the body
- diplegic = both legs
- quadriplegic = all limbs

Question 9

In spastic cerebral palsy, where is the lesion in the brain most likely to be?

1 - somatosensory cortex
2 - motor cortex
3 - broca cortex
4 - posterior parietal cortex

Answer 9

2 - motor cortex

Question 10

In spastic cerebral palsy, the lesion in the brain is most likely to be in the motor cortex. Which neurotransmitter are the neurons in the lesion less sensitive to, that results in over excitatory and hypertonia?

1 - serotonin
2 - dopamine
3 - glutamate
4 - GABA

Answer 10

4 - GABA

Inhibitory neurotransmitter
Less inhibition means more excitation

Question 11

Another form of cerebral palsy is dyskinetic/abnormal movement. Which part of the brain is the lesion most likely to have occurred in?

1 - somatosensory cortex
2 - motor cortex
3 - basal ganglia
4 - posterior parietal cortex

Answer 11

3 - basal ganglia

Important for initiating and stopping unwanted movements
If basal ganglia doesn’t work properly, patients can have unwanted movements

Question 12

Which 2 of the following can be caused by dyskinetic cerebral palsy, which is due to a lesion in the basal ganglia?

1 - chorea
2 - myoclonus
3 - fasciculations
4 - dystonia

Answer 12

1 - chorea
- random “dance-like” movements, since the small uncontrolled movements seem to move from muscle to muscle

4 - dystonia
- random, slow, and uncontrolled movements in the limbs and trunk

Question 13

Another form of cerebral palsy is ataxia movement. Which part of the brain is the lesion most likely to have occurred in?

1 - cerebellum
2 - motor cortex
3 - basal ganglia
4 - posterior parietal cortex

Answer 13

1 - cerebellum

Causes shaky or uncoordinated movements

Question 14

All of the following are features of ataxia cerebral palsy, EXCEPT which one?

1 - clumsy
2 - unstable movements
3 - random, slow, and uncontrolled movements in the limbs and trunk
4 - poor balance

Answer 14

3 - random, slow, and uncontrolled movements in the limbs and trunk

Question 15

Although all patients are unique, most children with cerebral palsy often have associated non-motor problems. Which of the following is most common?

1 - learning difficulties
2 - epilepsy
3 - squints
4 - hearing impairment

Answer 15

1 - learning difficulties

Question 16

Although all patients with cerebral palsy are unique, which of the following is NOT a common presentation of patients with cerebral palsy?

1 - abnormal tone (especially in infancy)
2 - delayed motor milestones
3 - abnormal gait
4 - feeding difficulty
5 - breathing difficulty
6 - pain in muscles/joints
7 - sleep disorders

Answer 16

5 - breathing difficulty

Abnormal gait
- some muscles stiffer than others
- often a scissor gate, due to over-excitation of adductor muscles
- toe walk can occur due to calf over activation

Question 17

All of the following can be used to diagnose cerebral palsy, but which is most common method?

1 - MRI (head and spine)
2 - clinical diagnosis
3 - biochemical workup
4 - genetic testing

Answer 17

2 - clinical diagnosis

Other approaches typically rule out other causes

Question 18

All of the following can be used alongside physical therapy to help treat the symptoms of cerebral palsy, EXCEPT which one?

1 - botulinum toxin type A injections
2 - diazepam
3 - rocuronium
4 - baclofen

Answer 18

3 - rocuronium
- non-depolarising neuromuscular blocker used in Anaesthesia

Baclofen = GABAb receptor agonist
Botulinum = blocks presynaptic release of acetylcholine
Diazepam = GABAa receptor agonist

Question 19

Is surgery offered in cerebral palsy?

Answer 19

• yes
• loosening tight muscles
• straighten bones that have been subject to abnormal muscle forces over time
• cutting certain nerves to reduce their associated movements or spasms

Question 20

Hypoxic (oxygen)-ischaemic (blood) encephalopathy is a term used to describe a lack of blood and oxygen to the brain during childbirth. How common is this?

1 - 0.3 per 1000 live births
2 - 3 per 1000 live births
3 - 30 per 1000 live births
4 - 300 per 1000 live births

Answer 20

2 - 3 per 1000 live births

Relatively rare in modern countries, likely to be higher in poorer countries

Question 21

Hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) is a term used to describe a lack of blood and oxygen to the brain during childbirth. How quickly can cells in the babies brain die due to HIE?

1 - seconds
2 - minutes
3 - hours
4 - days

Answer 21

2 - minutes

HIE can cause neurological or developmental problems

Question 22

Although the exact cause of hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) is unknown, which of the following are risk factors?

1 - low or high maternal BP
2 - Heart problems/stroke in the baby
3 - Uterus/placenta problems
4 - delayed labour
5 - emergency C-section
6 - reduced blood flow in pregnancy
7 - maternal trauma
8 - all of the above

Answer 22

8 - all of the above

Question 23

Babies affected by hypoxic (oxygen)-ischaemic (blood) encephalopathy (HIE) can present with all of the following, EXCEPT which one?

1 - unusual state of being awake and aware, such as highly alert or very low energy
2 - breathing difficulty
3 - projectile vomiting
4 - trouble hearing
5 - seizures/neurological issues
6 - muscle or reflex problems
7 - bradycardia
8 - organ failure

Answer 23

3 - projectile vomiting

Can have difficulty eating though