Cerebral Palsy

Cerebral palsy is a clinical diagnosis. Delays in developmental milestones are usually the earliest clue. Milestones acquired do not show regression. Other early signs include hand preference, prominent fisting, persistence of neonatal reflexes, and delay in emergence of protective and postural reflexes.

Topographic classification of CP includes monoplegic, diplegic, hemiplegic, and quadriplegic. Cases can also be classified into spastic, dyskinetic, ataxic, hypotonic, and mixed. Of these, spastic cerebral palsy with diplegia of the lower extremities and scissoring gait is the most common, accounting for 70% to 75% of cases. Imaging demonstrates periventricular leukomalacia around the lateral ventricles, with ischemia as the most common pathologic finding. Mild cases manifest with toe walking, whereas severe cases have flexion of the hips, knees, and elbows.

In hemiplegic cerebral palsy, the upper limb is predominantly affected. Palmar grasp reflexes may be present and can persist for years. Quadriplegic cerebral palsy, the most severe form, is characterized by polyporencephaly, polymicrogyria, and schizencephaly on neuroimaging studies. Pseudobulbar signs and optic atrophy is usually present in up to 50% of affected children.

Mental retardation (60%), visual impairment, and oculomotor impairments are common. In those children who develop cerebral palsy as a consequence of kernicterus, deafness, dystonia, choreoathetosis and, to a lesser extent, ataxia are the most common clinical findings, in addition to corticospinal tract involvement in a smaller proportion of patients. These are key points to remember when assessing adults who come for an evaluation of a new movement disorder and have a history of neonatal hyperbilirubinemia. Among children with cerebral palsy, 35% to 60% will have some form of epilepsy. Feeding difficulties, swallowing dysfunction, and drooling may complicate the clinical picture.

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