Cerebral Palsy

Nat. Hx

Congenital CNS

insult occurs b/f complete cerebrum dev.

RFs: multi birth, premie, chorioamnionitis

postnatally--> trauma/infxn

motor, some sense/cog.

may dev slowly in infant

milestone delays

motor abnormalities: 80%--> spaz hemi/di/quadriplegia. 20%--> dyskinesias

Other--> 50%--> seizure, 66%--> cog impair

HP

US fetus

MRI, CT, US

PT, Rx--> Botulinum toxin, antispasmotics (severe), anticonvulsants

Sx

Adaptive equip.

Hip dislocation, diff eat/breath, osteopenia/porosis

chronic MSK pain

adults--> CVD, CereVD, DIg disorder

Chiari Malformation I Nat Hx

ETI

congenital CNS

dysraphism--> defect in closure of midline strx

posterior cranial fossa

displacement tonsils/ medulla into f. magnum

causes CSF obstruction/medullary compressoin

NOT Associated w/ hydrocephalus in Kids, can cause hydrocephalus in adults

Strongly associated w/ Syringomyelia

Chiari Type II

Nat. Hx

ETI

dyraphism

small post. cranial fossa

bony/dura abnormalities

misshapen midline cerebellum

brainstem abnormalities

Vermis thru f. magnum

Asscociated w/ hydrocephalus/ myelomeningocele

puberty/adolescent

HA, neck pain, polyuria, prog. cerebellar ataxia, LE spaz

Apneic in infants

older kids--> scoliosis, weakness, syringomyelia

usually NOT asscosiate w/ hydrocephalus

early in life

prog. hydroceph/myelomeningocele

resp distress, stridor, episodic apnea, weak cry, facial weak, infant aspiration

B/L CN6 palsies

Syncopal episode, nystagmus, spaz in older kids

Syrinx in cervical/thoracic spine

Lat. X-ray

CT, MRI

Dandy-Walker Syndrome

Nat. Hx

DX

CNS congenital

dysraphism of metencephalon

agenesis of vermis, cystic (ependymal-lined cyst) dilation 4th ventricle, enlarged post cranial fossa

Dx: CT, MRI

CNS congenital

general asymptomatic

minor changes in skin over dysraphism

prevent--> mom folic acid

Spina bifida meningocele

SSX

fluid-filled cyst-like sac, extend off back over dyraphism