Cerebral Palsy for USMLE Step 2
51.7 هزار بار بازدید -
9 سال پیش
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Cerebral Palsy is a group
Cerebral Palsy is a group of motor syndromes related to an early insult to the brain.
CAUSES
Antenatal causes of Cerebral Palsy are up to 80% which are infection. Intrapartum is birth asphyxia which are 10% and happen during birth. Post natal Cerebral Palsy can be caused by near drowning, kernicterus and post natal infection. The most important risk factor is prematurity which has low birth weight. 20% of premature babies have cerebral palsy. They have periventricular leukomalacia and intraventricular hemorrhage and there can be periventricular hemorrhage. The next major risk factor for cerebral palsy is IUGR and Intrauterine infeciton such as CMV, Syphillis, VZV, Toxomplasmosis chorioamnionitis. Hypoxic Ischemic Injury and congenital abnormalities are associated with cerebral palsy. Brain Malformation can lead to cerebral palsy. Post-Natal stroke due to thromboembolism and Intracranial Hemorrhage is a common risk factors. Multiple pregnancies because it is associated with Low Birth Weight, more commonly associated with congenital coniditons and cord entanglement. Death of a co-twin then surviving twin has an increased risk of cerebral palsy.
CLINICAL FINDINGS
Primarily associated with motor symptoms, but there can be Mental Retardation, epilepsy, Hearing/visual, cognitive difficulties and finally there are speech and behavior secondary to motor deficiencies. Three main syndromes associated with cerebral palsy. Spastic Hemiplegia, Spastic Diplegia or Paraplegia and finally spastic quadriplegia, which is the most serious manifestation.
Spastic hemiplegia cerebral palsy with flexion of wrist and elbow. Walking delayed to 18-24 months. Foot has equinovarus, increased DTR and ankle clonus and Babinski sign is positive.
Paraplegia is bottom half of the body. There are contractions of bottom of the feet.
Quadriplegic Cerebral palsy is most severe all the limbs are contracted. All limbs are atrophic and they are completely bed ridden.
INVESTIGATIONS
There is no lab work up that will help out. MRI helps rule out other pathology. Hearing/Visual test and there can be genetic and metabolic evaluation of the patient.
TREATMENT
Multidisplinary effort. To decrease spasm there are some medications such as orla dantrolene Sodium, Baclofen (intrathecal) Botulinum can be used on a specific muscle group, specifically drooling. Surgical procedures are soft tissue which is psoas transfer release that helps loosen up hip abductors. Adductor tenotomy helps loosen up the hips so they can move legs more freely. Rhizotomy you can cut a few of the spinal nerves. Motorized wheel chair, special feeding device, typewriters and custom seating arrangements
CAUSES
Antenatal causes of Cerebral Palsy are up to 80% which are infection. Intrapartum is birth asphyxia which are 10% and happen during birth. Post natal Cerebral Palsy can be caused by near drowning, kernicterus and post natal infection. The most important risk factor is prematurity which has low birth weight. 20% of premature babies have cerebral palsy. They have periventricular leukomalacia and intraventricular hemorrhage and there can be periventricular hemorrhage. The next major risk factor for cerebral palsy is IUGR and Intrauterine infeciton such as CMV, Syphillis, VZV, Toxomplasmosis chorioamnionitis. Hypoxic Ischemic Injury and congenital abnormalities are associated with cerebral palsy. Brain Malformation can lead to cerebral palsy. Post-Natal stroke due to thromboembolism and Intracranial Hemorrhage is a common risk factors. Multiple pregnancies because it is associated with Low Birth Weight, more commonly associated with congenital coniditons and cord entanglement. Death of a co-twin then surviving twin has an increased risk of cerebral palsy.
CLINICAL FINDINGS
Primarily associated with motor symptoms, but there can be Mental Retardation, epilepsy, Hearing/visual, cognitive difficulties and finally there are speech and behavior secondary to motor deficiencies. Three main syndromes associated with cerebral palsy. Spastic Hemiplegia, Spastic Diplegia or Paraplegia and finally spastic quadriplegia, which is the most serious manifestation.
Spastic hemiplegia cerebral palsy with flexion of wrist and elbow. Walking delayed to 18-24 months. Foot has equinovarus, increased DTR and ankle clonus and Babinski sign is positive.
Paraplegia is bottom half of the body. There are contractions of bottom of the feet.
Quadriplegic Cerebral palsy is most severe all the limbs are contracted. All limbs are atrophic and they are completely bed ridden.
INVESTIGATIONS
There is no lab work up that will help out. MRI helps rule out other pathology. Hearing/Visual test and there can be genetic and metabolic evaluation of the patient.
TREATMENT
Multidisplinary effort. To decrease spasm there are some medications such as orla dantrolene Sodium, Baclofen (intrathecal) Botulinum can be used on a specific muscle group, specifically drooling. Surgical procedures are soft tissue which is psoas transfer release that helps loosen up hip abductors. Adductor tenotomy helps loosen up the hips so they can move legs more freely. Rhizotomy you can cut a few of the spinal nerves. Motorized wheel chair, special feeding device, typewriters and custom seating arrangements
9 سال پیش
در تاریخ 1394/01/06 منتشر شده
است.
51,701
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