Presentation on theme: "The Child with Motor Weakness"— Presentation transcript:
1 The Child with Motor Weakness Neurology ModulePediatrics II
2 Cerebral Palsy - Objectives At the end of this topic you should be able to:provide a clear definition of cerebral palsy;discuss aetiological and risk factors associated with cerebral palsy;explain the clinical features and associated impairments common to cerebral palsy;demonstrate an understanding of diagnostic methods;recognize the various methods of effectively managing cerebral palsy.
3 The Floppy Baby J.M., 17-month-old boy admitted because of cough Born preterm at 7 months age of gestation by a repeat Caesarean section; BW=1.3 kg; Apgar score not known to mother but resuscitation was reportedly done. He developed sepsis and stayed in the NICU for a month.Discharged with difficulty in feeding such that hewould often cough while sucking.
4 Case: J.M., 17 months old He was never able to regard, hold head, roll over, use his hand purposively, babbleor startle.He had one episode of febrile seizure.
5 Case: J.M., 17 months old Pertinent Physical Examination Findings: Wt=5.95 kg(<P5) Length=65.5cm(<p5) HC=42cm(<P5)awake but oblivious to surroundings, shrill cry,does not alert nor startle to sound, tongue midline,crackles over both lungsHead lag on traction maneuver, slips through on vertical suspension, truncal hypotonia, loops over on horizontal suspensionSpastic limbs, limited movement of both lower extremities with +++ DTRs
6 Salient Points 17 months old, with developmental delay Preterm birth (+) Neonatal asphyxia(+) Infection(+) History of seizuresMarked developmental delayNeurologic abnormalities - truncal hypotonia with spastic limbs, weakness of both lower extremities
7 QUESTION #1: Is there a neurologic disease? Yes, as evidenced by the abnormalneurologic examination.
8 QUESTION #2: Where is the lesion? The abnormalities in the tone (hypotonia) and movement (diplegia) point to the motor system.Weakness can be due to lesions in the :1. Central nervous system – Upper motor neuron(spasticity, hyperreflexia); may be accompanied bycerebral manifestations (seizures, cognition,language and sensory problems)2. Peripheral nervous system – Lower motor neuron(decreased to absent reflexes, flaccid)
9 QUESTION #2: Where is the lesion? J.M appears to have an upper motor lesionspecifically the cerebral hemispheres.
10 QUESTION #3: What is the nature of the lesion? Disorders of the motor system may be:1. Acute - strokes/vascular metabolic disordersinfection2. Chronic - cerebral palsy (static)congenital CNS lesiondegenerative disorders(progressive)
11 CEREBRAL PALSYRefers to a group of disorders characterized by motor abnormalities (tone, posture or movement) which are neither progressive nor episodic.The brain lesions are static and result from disorders of early brain development, usually insults in the perinatal period.They are not progressive but the symptoms may change in time.
12 CEREBRAL PALSY Clinical manifestations: 1. Delay in development – i.e. poor head control, delays in gross motor or fine motor development2. Motor deficit – depending on the area of the brain involved and usually the risk factors present3. Associated developmental disabilities – mental retardation, epilepsy, visual, hearing, speech and behavioral abnormalities
13 Types of Cerebral Palsy and the Major Causes PhysiologicTopographicEtiologicFunctionalSpasticAthetoidRigidAtaxicTremorAtonicMixedUnclassifiedMonoplegiaParaplegiaHemiplegiaTriplegiaQuadriplegiaDiplegiaDoublehemiplegiaPrenatal(e.g., infection, metabolic, anoxia, toxic, genetic, infarction)Perinatal(e.g., anoxia)Postnatal(e.g. toxins, trauma, infection)Class I –no limitation of activityClass II – slight to moderate limitationClass III – moderate to great limitationClass IV –no useful physical activity
17 Diagnosis1. Thorough history, developmental assessment, physical and neurological examinations2. Hearing and vision screening3. EEG if with seizures4. If no possible etiology or risk factors for CP, may do diagnostic tests as:Neuroimaging – CT/MRIMetabolic screeningChromosomal study
18 Differential Diagnosis 1. Motor delays from congenital structural lesions2. Progressive disorders of the brain – white matter diseases3. Muscle disorders- myopathies,dystrophies.