Cerebral Palsy- Enrique Chaves

Question 1

define CP

Answer 1

a static (non-progressive) encephalopathy (brain injury) characterized by early onset of impaired movement and or posture

Question 2

is CP useful as a medical term?

Answer 2

no not specific to cause or clinical manafestations, its a lay term only

Question 3

etiology of prenatal cp (before birth)

Answer 3

intrauterine infection
chromosomal disorders
neurogenetic disorders

Question 4

etiology of perinatal cp (at birth)

Answer 4

birth asphyxia (only 6%)
-low APGAR scores
-metabolic acidosis
-neonat. seizure
maternal bleeding
Rh incompatibility (kernicterus)- yellow staining of the BG, billirubin too high and affects BG which is responsible for fluidity of movement

Question 5

etiology of postnatal cp (after birth up to 2-3 years)

Answer 5

stoke
brain hemorrhage
infection or sepsis

Question 6

classifications of CP:

topographical

Answer 6

hemiplegia (one side)
diplegia (both legs)= scissoring gait
quadriplegia (arms and legs)= seen in full term babies who suffer lack of o2

Question 7

classifications of CP:

neurological

Answer 7

spastic (stiff)
athetoid (dyskinetic) worm like
ataxic (poor balance)
hypotonic

Question 8

what do u have to be aware of with a hypotonic cp diagnosis?

Answer 8

that its a misdiagnosed mm or connective tissue disease, check with DTRs, if they are absent, its not brain related its mm related (SMA, etc.), but if it is a brisk reflex, its brain related (CP).

Question 9

diff. between rigidity and spasticity

Answer 9

rigitidy= cogwheel
spasticity= clasp knife

Question 10

CP clinical manifestations that come late

Answer 10

primitive reflexes persist
delayed milestones
poor head growth
delayed speech and language
strabissmuss (lazy eye) very often associated with diplegia

Question 11

whats a 4+ grade in reflexes?

Answer 11

clonus, multiple responses

Question 12

whats a normal grade for reflexes?

Answer 12

2+

Question 13

whats a 3+ grade for reflexes?

Answer 13

brisk, increased

Question 14

levels of alertness in infant as part of neuro exam

Answer 14

alert and awake
irritible- cortical irritibility sign of cp (hard to make happy)
sonmolent- hard to arouse
delirium
stupor
comatose

Question 15

how to do head circumference

Answer 15

most prominent part of the forehead around the most prominent part of the occiput, measure 3 times, one right where u think, a lil above, a lil below and the biggest measurement wins

Question 16

how do u know where or not to be concerned about head circumference?

Answer 16

if u’ve been measuring from birth and it starts dropping off or increaseing a lot and crossing norms

Question 17

normal head circumference

Answer 17

2 SD

Question 18

abnormally large

Answer 18

> 2 SD

Question 19

microcephaly

Answer 19

3 SD below mean, 2 and a child can still be “normal”

Question 20

+ babinski reflex is normal until when?

Answer 20

18 mo., after that it’s abnormal

Question 21

lissencephaly

Answer 21

smooth brain

Question 22

pachygyria

Answer 22

thick layer brain

Question 23

when does neuronal migration occur

Answer 23

28 weeks

Question 24

each neuron is guided by what to its final destination

Answer 24

glial cells

Question 25

schizencephaly results in a child with what kind of cp?

Answer 25

hemiplegia (split brain)

Question 26

heterotopia

Answer 26

misplaced brain

Question 27

polymicrogyria

Answer 27

clusters of tiny gyri

Question 28

signs of CP: birth to one month

Answer 28

``` weak/absent sucking and swallowing bradycardia/apnea high pitched cry jittery seizures abnormal primitive reflexes ```

Question 29

signs of CP at 3 mo.

Answer 29

``` feeding probs tongue thrust irritability hypotonia/advanced head control in prone one or both hands fisted cortical thumb brisk DTRs (3+ or 4+) strabismus prim. reflexes persist ```

Question 30

signs of cp at 6 mo.

Answer 30

``` delayed milestones handedness/fisting hypertonia difficult to dress little spontaneous mvmt arching, tendency to stand persistent reflexes ```

Question 31

signs of CP at 9 mo

Answer 31

``` delated milestones abnormal or asymmetric crawl abnormal reaching tremors abnormal movements keeping arms flexed ```

Question 32

signs of CP at 12 mo

Answer 32

scissoring toe walking athetoid movements handedness

Question 33

main indicator of birth asphyxia?

Answer 33

fetal HR

Question 34

what is PVL?

Answer 34

Periventricular leucomalacia = injury to white matter around ventricles- caused by hopoxia/ischemia

Question 35

all neurons start where?

Answer 35

germinal matrix zone