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Cerebral palsy and hypoxic-ischaemic encephalopathy

Definition:

  • Cerebral Palsy is a group of permanent movement disorders that appear in early childhood, attributed to non-progressive disturbances that occurred in the developing fetal or infant brain.

Etiology:

  • Caused by factors that affect brain development before, during, or shortly after birth. These include premature birth, maternal infections, genetic mutations, and birth complications like asphyxia.

Types:

  1. Spastic CP: Characterized by stiffness and movement difficulties.
  2. Dyskinetic CP: Involves uncontrolled movements.
  3. Ataxic CP: Causes poor balance and coordination.
  4. Mixed CP: A combination of the above types.

Clinical Features:

  • Varying levels of muscle control, coordination, and tone.
  • Delays in reaching motor milestones.
  • Speech and swallowing difficulties.
  • Intellectual disabilities in some cases.
  • Seizures, vision and hearing problems.

Diagnosis:

  • Based on developmental history and physical examination.
  • Neuroimaging (MRI) to identify brain abnormalities.
  • Multidisciplinary assessment for associated conditions.

Management:

  • Multidisciplinary approach including physical therapy, occupational therapy, and speech therapy.
  • Medications for spasticity and seizures.
  • Orthopedic interventions for musculoskeletal complications.
  • Educational and social support.

Hypoxic-Ischaemic Encephalopathy (HIE) Learning Notes

Definition:

  • HIE is a type of brain dysfunction that occurs when the brain gets insufficient oxygen or blood flow for a period of time.

Etiology:

  • Commonly occurs around the time of birth due to birth asphyxia.
  • Other causes include cardiac arrest, severe hypotension, and respiratory failure.

Pathophysiology:

  • Hypoxia and ischemia lead to a cascade of events causing cell death and brain injury. This can result in cerebral edema and further compromise cerebral blood flow.

Clinical Features:

  • Severity ranges from mild symptoms to severe impairment or death.
  • Symptoms include poor muscle tone, weak reflexes, shallow breathing, and reduced consciousness.
  • Severe cases can lead to seizures, coma, and multi-organ failure.

Diagnosis:

  • Clinical assessment including Apgar scores, blood gases, and neurological examination.
  • Neuroimaging (MRI or CT) for extent and pattern of brain injury.
  • Continuous EEG monitoring in severe cases.

Management:

  • Immediate resuscitation and stabilization.
  • Therapeutic hypothermia (cooling) is the standard treatment for neonates with moderate to severe HIE.
  • Supportive care and monitoring for seizures and other complications.

Prognosis:

  • Varies based on severity and response to treatment.
  • Can result in long-term neurological deficits, including cerebral palsy, cognitive impairments, and epilepsy.

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