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CEREBRAL PALSY

DEFINITION
A group of motor syndromes disorders of early brain development Caused by : acetic, metabolic, ischemic,

infections & acquired etiology

CLINICAL MANIFESTATION
Spastic-Hemiplagia :
Decrease spontaneus movement Arm more involved than the leg Walking is usually delayed 19 24 mo Circumductive gait (+) Examination of extremities : growth arrest hard & thumnail Spasticity (+) ankee Equinovarus deformity of the foot

Ankee dones & a. babinsky sign (+)


Deep tendon reflex Weakness of the hard & foot dorsoflexurs Seizure disorders (+) 1/3 case Cognitive abnormality (+) mental retardation 25%

CT Scan / MRI : atrophic cerebral hemisphere with a


dilated lateral ventricle contra lateral

Spastic diplagia :
Bilateral spsticity of the legs > arm Examination of the child : Specificity in the legs Brisk reflexes, ankee donus & bilateral babinsky (+)

Walking is delayed, equirovarus & bilateral


babinsky (+)

Severe spastic diplagia : disuse atrophy & impaired growth of lower extremities dispropotionate growth with normal development of the uppertusio

Prognosis :
intelectial excellent seizure is minimal Periventricular leucomalacia (+) MRI : cererity white matter injury

Spastic Quadriplegia :
Severy form of CP Motor impairment of all extremities, mental retardation & seizure Swallowing difficulties are common cipranuclear buloar palsys aspiration pneumonia

MRI : severe PVL & multicystic cortical encephalomalacia Neurologic exam. : increased tore, spasticity all

extremities, decreased spontaneus movements, brisk


reflexes & plantar extersa responses Flexion contractures of the knees & elbows

Speech & visual abnormalities

Athetoid CP
Choreo athetoid or extrapyramidal cp Less common than spastic CP Hypotonic with poor head control & head lag Increased variable tore with rigidity & dystonia several years Feeding may be difficult, & tongue thrust & drooling Speech may be absent or centences are siurred, voice modulation is impaired UMN (-) Seizure are uncommon

DIAGNOSIS
History Physical examination Preclude a progressive disorder Of the CNS : degenerative disease metabolic disorders

spiral cord tumor


muscular dystrophy

MRI determined the location & extent of structural lesion / brain, congenital malformation MRI scan of the spiral card spiral card pathology Genetic evaluation congenital malformations / metabolic disorder

TREATMENT
A team of physicians from specialties Parent :

Should be taught how to handle their child in


activity Super vision of series of exercises designed to present the development of contractures Spastic diplegia assistance of adaptive equipment

walkers, poles & stading frames


Spasicity of the lower ext./hip dislocation surgical soft tissue prosedure

Severe spastic diplegia : A. rhizotory prosedure


A tight heel cord spastic hemiplegia terotomy of the achilles tendon Quandriplegia motorized wheel chairs Communication skill bliss symbols

Learning & attention deficit disorders & mental


retardation psychologist & educator

Several drug for spasticity : Dontrolere sodium Benzodiazepires Baclofen

Severe spasticity Baclofen intra thecal


Rigidity, dystonia, and spastic quadriparesis levodopa Dystonia carbamazepine / trihexyphenidyl