- **Lesch-Nyhan can mimic CP, so it is
important to screen children with an initial diagnosis of CP for Lesch-Nyhan,
especially if the prenatal and perinatal courses were normal.**
- a static
motor encephalopathy that arises during the perinatal period from a lesion or
defect in the developing brain.
impaired vision, developmental delay, or speech problems may accompany these
- 5 types...
- is a form of
cerebral palsy that is marked by
bilateral spasticity of the lower extremities, which may be mild or
little deficit in the upper extremities.
Scissoring of the lower
extremities may be present when the child is suspended vertically.
- In mild or
moderate cases, walking is delayed, and the child may walk on tiptoes.
- In some
instances, the feet are in an equinovarus posture.
injury pattern arises commonly in
preterm infants from ischemia
to the vascular border zone around
the cerebral ventricles and resultant periventricular leukomalacia,
as reported for the infant in the vignette.
prognosis for normal cognitive
development and no seizure activity is
good among children who have spastic diplegia.
supportive care may be limited to
orthopedic interventions and physical therapy to reduce spasticity.
palsies can be more variable and severe in prognosis.
hemiplegia is accompanied by
more upper than lower extremity spasticity
often is delayed until 2 years of age.
- This pattern
frequently is due to an atrophic
cerebral hemisphere; intrauterine stroke is one possible cause.
- At least
25% of children who have spastic
hemiplegia are cognitively impaired, sometimes with mental retardation,
and they may have seizures.
- is more
increased tone in all extremities,
often more in the lower
tendency toward mental retardation, seizures, feeding difficulties
because of dysfunctional swallow, speech problems, and cortical visual
- can be
similar in presentation to spastic
although the basal ganglia are more
involved, resulting in more dystonia and extraneous movement.
- Rarely, this
pattern follows kernicterus
- Currently it
is seen more often with
hypomyelination of the basal ganglia following hypoxic-ischemic injury in an
infant who is born at term.
palsy is rare. A child who presents with ataxia and developmental delay should
be evaluated for underlying disorders such as juvenile Huntington disease or
Caring for the
child who has cerebral palsy requires a multidisciplinary approach that involves
physicians, physical and occupational therapists, speech pathologists, social
workers, and educators. Adaptive equipment such as braces, motorized chairs, and
communication boards may be necessary. Nutritional guidance is important, and
feeding devices may be necessary because of dysfunctional swallowing and
aspiration risk. Spasticity may be managed with drug treatment (benzodiazepines,
dantrolene, and baclofen), intrathecal baclofen pumps, dorsal root
rhizotomy, or intramuscular botulinum toxin injections. Parental support,
including visiting health nurse, financial counseling, and respite care, can be
Haslam RH. Encephalopathies: cerebral palsy. In: Behrman RE, Kliegman
RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed.
Philadelphia, Pa: WB Saunders Co; 2000:1843-1845
Liptak GS. The pediatrician's role in caring for the developmentally
disabled child. Pediatr Rev. 1996;17:203-210