View source for Cerebral palsy

==Background==
*Leading cause of childhood disability effecting function and development.
*Defined as a group of disorders involving motor or postural abnormalities that are noted during early development<ref>Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51.</ref>
**Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age<ref>Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.</ref>
*Associated with
**Birth: [[hypoxia]], [[placental abruption]], prolonged labor, [[uterine rupture]]
**Child: [[jaundice]]/kernicterus, low-birth weight, prematurity
**Mother: infection (prenatal), infertility treatment, multiple births, [[thyroid disorder]], [[seizure]] disorder

===Classification<ref>Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000</ref>===
*Spastic cerebral palsy is the most common type, ~80% of cases

'''Spastic diplegia (30-40%)'''
*Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities.

'''Spastic hemiplegia (20-30%)'''
*One side of the body effected, including an upper and lower extremity
*Upper extremity spasticity effected more than lower extremity
**Double hemiplegia: when both arms are more involved than the legs

'''Spastic quadriplegia (10-15%)'''
*Cerebral palsy affecting all 4 extremities and the trunk (full body)

'''Dyskinetic cerebral palsy'''
*Athetoid, choreoathetoid, and dystonic
*Extrapyramidal signs characterized by abnormal movements; hypertonicity

'''Mixed cerebral palsy'''
*Mixture of spastic and dyskinetic components without predominant area

'''Hypotonic cerebral palsy'''
*Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes

'''Monoplegia'''
*Rare: One limb involved, either an arm or a leg
*Must rule out other causes.

==Clinical Features==
*Abnormal muscle tone (most common)
**Hypertonia > hypotonia
*Intellectual disability (30-50%)<ref>Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.</ref>
*Speech and language impairment
*Ophthalmologic impairment
*[[Hearing loss|Hearing impairment]]
*Oromotor dysfunction
*[[Epilepsy]]
*Disease classified according to resting tone and limb involvement

==Differential Diagnosis==
===[[Weakness]]===
*'''Neuromuscular weakness'''
**UMN:
***[[CVA (Main)]]
***[[Hemorrhagic stroke]]
**Spinal cord disease:
***Infection ([[Epidural Abscess (Spinal)]]) 
***Infarction/ischemia
***Trauma ([[Spinal Cord Syndromes]]) 
***Inflammation ([[Transverse Myelitis]])
***Tumor
**Peripheral nerve disease:
***[[Guillain-Barre syndrome]]
***[[Tick paralysis]]
**NMJ disease:
***[[Botulism]]
***[[Organophosphate toxicity]]
***[[Lambert-Eaton myasthenic syndrome]]
**Muscle disease:
***[[Rhabdomyolysis]]
*'''Non-neuromuscular weakness'''
**Can't miss diagnoses:
***severe infection/[[Sepsis (Main)]]
***[[Hypoglycemia]]
***Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
****[[Hypokalemic periodic paralysis]]
****[[Thyrotoxic periodic paralysis]]
***Respiratory failure
**Emergent Diagnoses:
***Symptomatic [[Anemia]]
***Severe dehydration
***[[Hypothyroidism]]
***Malignancy

==Evaluation==
*Rule out [[Baclofen withdrawal]] in patient being treated for spasticity with Baclofen pump.

==Management==

==Disposition==

==See Also==

==External Links==

==References==
<references/>

[[Category:Neurology]]
[[Category:Pediatrics]]