The most common cause of crippling in children, cerebral palsy is an umbrella term for a group of neuromuscular disorders resulting from prenatal, perinatal, or postnatal central nervous system (CNS) damage. Although nonprogressive, these disorders may become more obvious as an affected infant ages.
Three major types of cerebral palsy occur—spastic, athetoid, and ataxic—sometimes in mixed forms. Motor impairment may be minimal (sometimes apparent only during physical activities such as running) or severely disabling. Associated defects—such as seizures, speech disorders, and mental retardation—are common.
The prognosis varies. With mild impairment, proper treatment may make a near-normal life possible.
Cerebral palsy is most common in premature infants (anoxia plays the greatest role in contributing to cerebral palsy) and in those who are small for their gestational age. Cerebral palsy is common in whites and is slightly more common in males than in females.
Conditions that result in cerebral anoxia, hemorrhage, or other CNS damage are probably responsible for cerebral palsy.
Prenatal causes include maternal infection (especially rubella), radiation, anoxia, toxemia, maternal diabetes, abnormal placental attachment, vaginal bleeding, malnutrition, and isoimmunization.
Perinatal and birth difficulties
Examples of perinatal and birth difficulties include inadequate oxygenation of the brain, forceps delivery, breech presentation, placenta previa, abruptio placentae, depressed maternal vital signs from general or spinal anesthetic, and prolapsed cord with delay in the delivery of the head. Premature birth, prolonged or unusually rapid labor, and multiple birth (especially infants born last in a multiple birth) may also cause cerebral palsy as well as bleeding into the brain.
Infection or trauma during infancy
Cerebral palsy may follow kernicterus resulting from erythroblastosis fetalis, brain infection, head trauma, prolonged anoxia, brain tumor, cerebral circulatory anomalies causing blood vessel rupture, and systemic disease resulting in cerebral thrombosis or embolus.
Signs and symptoms
Each type of cerebral palsy typically produces a distinctive set of symptoms, although some children display a mixed form of the disease.
Spastic cerebral palsy
Spastic cerebral palsy is the predominant form, affecting about 70% of patients. This form of the disease is characterized by hyperactive deep tendon reflexes, increased stretch reflexes, rapid alternating muscle contraction and relaxation, muscle weakness, underdevelopment of affected limbs, muscle contraction in response to manipulation, and a tendency toward contractures. A child with spastic cerebral palsy typically walks on his toes with a scissors gait, crossing one foot in front of the other.