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CEREBRAL PALSY
• “Palsy”: damaged, something is wrong with it. It is an old word.
• Applied to a group of congenital nervous system disorders.
• Christy Brown in “My Left Foot” (1989) had CP
• Main indications in baby is movement. Kids usually have “cat” response: will move body to protect selves in case they
fall. CP kids don’t have this response. This is a brain response, not spinal cord.
• Pathology is in BRAIN, not in spinal cord
• Spastic paralysis: they have nerves going to all systems, but they have an inability to response. Could be
bulbar/cerebellar/cerebral centre that is responsible.
• Spastic: usually cerebral pathology.
• Flaccid: usually peripheral pathology
• They have speech impairments: can make sounds, but hard to understand without spending time with them.
• Intellectual deficits.
Etiology
In notes, in order of most likely to least likely.
Brain injury: not likely because we see this in all types of delivery.
STROKE
• Can be caused by atherosclerotic plaque, air embolus, injected substance…
• Air: would need 60-100 mL of air to block an artery. Less than this: it would just dissolve in blood.
• Blood exchanges nutrients/oxygen with brain tissue via CSF.
• Rapidly evolving symptoms, can be focal or global.
• DDX ischemia: symptoms won’t last >24 hours; stroke is permanent, TIA is reversible. You do recover some function
in stroke…
• Stroke: in brain, always looks triangular due to pattern of blood flow (“flowers”). Area that is not perfused will die.
• Lacunes: can form from chronic hypertension. A unique type of infarct that is associated with hypertension. These
happen in the pons: which is a commissure. Connections between different parts of the brain. Associated with cranial
nerves: get focal movement problems. Spastic paralysis in one area… Usually the other side of the brain can
compensate for some amount of damage.
• CTs are generally “messy” in early strokes, MRIs easier to read. Looking for areas of varying density, liquification, on
CT.
HYPERTENSION
• Under CNS control
• If you get excited, the cerebral arteries “alter their calibre” to maintain perfusion.
• Brain will sometimes raise blood pressure to make sure that it can get oxygen.
• Hypo/hypertension: beyond the auto-regulatory range. Body can’t compensate for changes in blood pressure.
• “opathy” implies pathology
VENOUS INFARCTION
• Sinuses carry blood through the brain. All connected.
• Superior sagittal sinus: can be subject to thrombosis. Can happen after childbirth (in the mother)
• See seizures and headache
• Cavernous sinus: lots of nerves and arteries go through it. When it swells from thromobosis, will affect artery, nerve,
vein. Swollen eyelid, edematous conjunctiva, all nerves going to eye will be affected: abducens, oculo-motor, CNII
(doesn’t pass through it, but pressure is exerted on it.)
• History will give you a clue as to what has happened.
CONCUSSION
• Can’t really do much at first: watch and wait.
• May or may not lose consciousness.
• Body’s response to trauma: you pass out so that you will stop doing the activity that caused the trauma.
• May be residual damage after successive concussions: contusions.
• If you see other symptoms, you have gone beyond the point of a simple concussion. Organic changes like motor or
personality changes, this falls under a different definition.
CONTUSION (BRUISE)
• Looks like a bruise anywhere else on the body (post-mortem)
• Coup and counter-coup lesions: brain moved in skull and caused injury on the other side.
• Classified based on where they are.
o Epidural hematoma: Usually happens to middle meningeal artery. Break bone under it and you will
definitely have a bleed. Pressure is the problem: buildup of blood squeezes the brain. Amount of CSF
produced is reduced. Progressive accumulation of blood.
o Subdural: From repeated trauma, ruptured bridging veins. On CT scan (in class): bleed is dispersing
around the brain. Has somewhere to go under dura.