The Child with Motor

Weakness
Neurology Module
Pediatrics II
 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.
The Child with a Motor Weakness

 C.R.,2 yrs. Old, F, referredto

neuropdevelopmental clinic because of
delay in walking
 Born by CS, term, BW 1.5 kg, had
respiratory distress and resuscitated
 Frerquent Cough a & fever , 2
hospitalizations.
 Described as quiet, passive
 Able to hold head up and steady at 6
months, rolled over at 8 months; sat
alone 1 yr.
 Able to take steps at 1 ½ yrs.
 Vocalized at 6-8 months
 Socialized with mother at 6 months and
other siblings at 1 ½ yrs.
P.E / N.E.
Temp= 37.3’C; PR=95/min; RR=31/min;
HC=48 cm; Wt = 9.2 kg; Ht=75 cm.
No skin lesions, no dysmorphisms
Awake, alert, responds to sounds and
simple commands
Follows moving objects in all directions,
Pupils 2 mm equally reactive to light
 Neuro exam
 No facial asymmetry; with drooling
 Moves all extrwemities, the left more than
the right
 Spastic Rt UE and Rt LE; left
extremities=normal tone.
 Deep tendon reflexes: Rt ++++; Lt ++
 BaBINSKI + Rt.
 Salient Points

 2 yr. old F
 Asphyxia in the newborn period
 Delayed motor development
 Delayed language development
 Rt hemiparesis
 Hyperreflexia (Rt)
 Babinski (Rt)000
 QUESTION #1: Is there a
neurologic disease?
 Yes, as evidenced by the abnormal
neurologic examination.
 QUESTION #2: Where is the
lesion?
The abnormalities in the tone
(spasticity) and movement ( hemiparesis)
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 by
cerebral manifestations (seizures, cognition,
language and sensory problems)
2. Peripheral nervous system – Lower motor neuron
(decreased to absent reflexes, flaccid)
 QUESTION #2: Where is the
lesion?
 C.R appears to have
an upper motor lesion
specifically the cerebral
hemispheres.
Spasticity is the opposite with
hyperextension of the limbs as in this
patient
QUESTION #3: What is the nature
of the lesion?
 Disorders of the motor system may be:
1. Acute - strokes/vascular
metabolic disorders
infection
2. Chronic - cerebral palsy (static)
congenital CNS lesion
degenerative disorders
(progressive)
 CEREBRAL PALSY
 Refers 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.
 CEREBRAL PALSY
Clinical manifestations:
1. Delay in development – i.e. poor head control,
delays in gross motor or fine motor
development
2. Motor deficit – depending on the area of the
brain involved and usually the risk factors
present
3. Associated developmental disabilities – mental
retardation, epilepsy, visual, hearing, speech
and behavioral abnormalities
 Types of Cerebral Palsy and the
Major Causes
Physiologic Topographic Etiologic Functional
Spastic Monoplegia Prenatal Class I –
Athetoid Paraplegia (e.g., infection, no limitation of
metabolic, activity
Rigid Hemiplegia anoxia, toxic, Class II – slight
Ataxic Triplegia genetic, to moderate
infarction)
Tremor Quadriplegia limitation
Perinatal Class III –
Atonic Diplegia
(e.g., anoxia) moderate to
Mixed Double great limitation
Postnatal
Unclassified hemiplegia (e.g. toxins, Class IV –
trauma, no useful
infection) physical activity
Topographic Classification

Diplegia Hemiplegi Quadriplegi

a a

More
Affected
Less
Affected
Physiologic Classification

Hypotonic Cerebral
Palsy
Physiologic Classification

Spastic Diplegic
Cerebral Palsy
 Diagnosis
 1. Thorough history, developmental assessment,
physical and neurological examinations
 2. Hearing and vision screening
 3. EEG if with seizures
 4. If no possible etiology or risk factors for CP,
may do diagnostic tests as:
Neuroimaging – CT/MRI
Metabolic screening
Chromosomal study
 Differential Diagnosis
1. Motor delays from congenital structural
lesions
2. Progressive disorders of the brain –
white matter diseases
3. Muscle disorders- myopathies,
dystrophies.
 Management
 Multidisciplinary
1. Pediatrician
2. Neurologist
3. Rehabilitation specialists
4. Physical and occupational therapists
5. Developmental psychologists
6. Education specialists
7. Orthopedic surgeons
8. Social workers
Thank
you!