Cerebral palsy in children
Introduction
Introduction to Pediatric Cerebral Palsy Pediatric cerebral palsy, the full name of cerebral palsy in children, is a non-progressive brain injury caused by various reasons within 1 month after birth. The main clinical manifestations are central dyskinesia and abnormal posture. The performance of cerebral palsy varies depending on the cause and type, but it is more common in the early stage: early symptoms of the first half of the cerebral palsy (within 6 months). basic knowledge The proportion of illness: 0.025% Susceptible people: seen in young children Mode of infection: non-infectious Complications: epilepsy
Cause
Pediatric cerebral palsy
Perinatal risk factors (45%):
Premature birth and low birth weight, cerebral hypoxia-ischemia, birth trauma, congenital brain development abnormalities, nuclear jaundice and congenital infections.
Environmental factors (25%):
Parental smoking, alcoholism, drug abuse, maternal mental illness, diabetes during pregnancy, vaginal bleeding, pregnancy-induced hypertension syndrome, placenta previa, threatened abortion or contraceptives, drugs for treating infertility, and fetus-preserving drugs.
Maternal factor (10%):
High birth rate, high pregnancy time, history of stillbirth, premature birth, abortion history, twin or multiple births, fetal developmental delay, intrauterine infection, intrauterine distress, placental abruption, placental dysfunction, severe pregnancy response, umbilical cord around neck , urgency, inappropriate midwifery, delivery of forceps, breech delivery, long labor, premature or expired low birth weight infants, postnatal asphyxia, aspiration pneumonia, hypoxic ischemic encephalopathy, delayed jaundice or jaundice, Intracranial hemorrhage, head trauma, convulsions, infection, poisoning and malnutrition.
Prevention
Cerebral palsy prevention
(1) Pre-natal prevention
1. Pre-marital health care: universal prenatal screening, counseling on sexual health, fertility and genetic diseases for both men and women preparing for marriage; counseling on issues such as marriage and maternity, and diseases that may affect both marriage and childbearing Medical examination, medical advice.
2, do a good job of pregnancy health: health education, regular prenatal examination; increase nutrition; prevent the occurrence of infectious diseases, avoid prenatal infections and taking contraindications, do not touch X-rays, chemical poisons, etc., strengthen labor protection in the third trimester To reduce premature birth.
(2) Prevention of perinatal period
1. Improve the rate of hospital delivery in rural areas and strengthen the birth control of pediatricians.
2, the rational use of oxytocin, popularization of neonatal new method of recovery technology.
3. Avoid the birth of premature and low birth weight children.
4. Prevention of asphyxia and intracranial hemorrhage.
5, prevention and treatment of hyperbilirubinemia.
(3) Prevention after birth
1. Prevent the occurrence of infectious diseases:
(1) Carry out hospital delivery.
(2) Pay attention to protecting the skin of newborns.
(3) Keep the umbilical part of the newborn dry and clean.
(4) Closely observe the growth and decline of jaundice.
(5) Pay attention to the observation before and after.
(6) Implement breastfeeding.
2, the establishment of high-risk children files, the development of neonatal neurobehavioral measurement, regular physical examination (1 to 2 times a month), at the same time, do Vojta posture reflex examination.
3, the correct treatment of lumbar puncture: lumbar puncture a small amount of brain effusion for examination, to understand the nature and condition of the disease, to provide a basis for correct diagnosis and treatment, thereby reducing the incidence of intracranial disease sequelae, parents should cooperate closely, Responsible for the health of the child.
4. Prevent the occurrence of febrile seizures.
Complication
Cerebral palsy complications in children Complications
1. Health and physical barriers
Children with cerebral palsy are generally shorter than normal children, have poor nutrition, often have respiratory problems and are prone to respiratory infections, as well as chewing, sucking, swallowing disorders and salivation, all of which have adverse effects on children.
2. Intelligence, emotional and behavioral disorders
The concurrent intelligence has the highest rate of low rate, hyperactivity, autism, stubbornness, self-willedness, irritability, solitude, high mood swings, sometimes compulsive, self-injury, invasive behavior, and difficulty in IQ measurement.
3, epilepsy
39% - 50% of children with cerebral palsy induce epilepsy due to fixed lesions in the brain, especially children with severe mental retardation. Epilepsy not only hinders the treatment of cerebral palsy, but repeated convulsions increase the risk of brain damage.
4, feeling the obstacle
1 Perception, cognitive impairment: The function of children with cerebral palsy looks good in this respect, but it has been confirmed that there are two points of recognition, shape identification, spatial perception and other perceptions, cognitive impairment.
2 hearing impairment: children with cerebral palsy with hearing impairment is not uncommon. According to statistics, 5% is completely deaf, 6% is partial hearing loss, and hearing impairment is more common in children with cerebral palsy of the hand and foot. This is mainly caused by the sequela of scutellaria Caused.
5 eyes and visually impaired children with cerebral palsy have 55% to 60% of them have visual problems. The most common one is strabismus, which usually occurs in infancy. The strabismus gradually disappears with age, and the baby who knows more than 6 months has Strabismus, should go to the hospital for treatment.
5, language barriers
The incidence of language disorders in children with cerebral palsy is 65%-95%. Among them, the incidence of quadriplegia is high. It is often caused by difficulty in sucking, difficulty in swallowing and chewing, and the pronunciation is unclear. Expression disorders, even aphasia, due to vocalization, dyskinesia of motor organs and movement disorders of the extremities, hearing impairment, intelligence and growth environment.
6, learning disabilities
Due to brain damage, vision, hearing, language, mental retardation, inattention, learning motivation is not strong, often emotional, learning ability is affected.
7, dental and dental problems
Children are prone to tooth and gum disease, and the treatment is difficult. First, due to the fact that there are many dental diseases, and because children are not easy to cooperate and abnormal exercise, nervous, etc., they rarely receive dental treatment, and children with cerebral palsy are more common in dental diseases. It is dental caries, as well as hyperplasia of the teeth due to the use of anticonvulsants, dental inflammation, dentition and occlusion abnormalities.
Symptom
Symptoms of cerebral palsy in children Common symptoms Mental retardation irritability Epilepsy and epileptic seizures Asymmetric tension Neck reflex twitching Fatigue Cerebellar ataxia Brain development Slow child crying Unresponsiveness Slow
First, the performance of cerebral palsy is various due to different causes and types, but early in the early stage: early symptoms of cerebral palsy in the first half (within 6 months).
1. The body is weak and spontaneous exercise is reduced. This is a symptom of low muscle tone. It can be seen in one month. If it lasts for more than 4 months, it can be diagnosed as severe brain injury, mental retardation or muscle system disease.
2, the body is hard, this is the symptoms of hypertonic muscle, can be seen in a month, if it lasts more than 4 months, can be diagnosed as cerebral palsy.
3, slow response and no name, this is an early manifestation of mental retardation, generally considered to be slow at 4 months, no response at 6 months, can be diagnosed as mental retardation.
4, head circumference abnormalities: head circumference is an objective indicator of the development of the brain's morphology, brain damage children often have head circumference abnormalities.
5, breastfeeding difficulties, do not suck after birth, sucking weakness or refusal to suck, tired and weak after sucking, often coughing, spitting milk, mouth can not be closed very well, poor weight gain.
6, fixed posture, children are very quiet after birth, crying weak or continuous crying, often due to brain damage caused by abnormal muscle tension, such as angulation, frog position, inverted U-shaped posture, etc., after birth It will be visible in the month.
7, do not laugh: If you can not smile for 2 months, 4 months can not be lol, can be diagnosed as mental retardation.
8, hand fist: If 4 months still can not open, or thumb adduction, especially the presence of one side of the upper limbs, has important diagnostic significance.
9, body twist: 3-4 months of babies if the body is reversed, often suggesting extrapyramidal injury.
10, head instability: such as 4 months prone can not raise the head or sit when the head can not be vertical, often an important sign of brain damage.
11, strabismus: 3-4 months of babies with strabismus and poor eye movements, can indicate the presence of brain damage.
12, can not reach out to grab things: such as 4-5 months can not reach out to grab things, can be diagnosed as mental retardation or cerebral palsy.
13, gaze hands: 6 months later still exist, can be considered for mental retardation.
14, children are easy to stun: convulsions, screams or irritability.
15, spontaneous exercise is less or not moving or easy to play, the whole body is soft, muscles are loose or the body is hard, often smashing out from the sputum.
Second, some brain damage is mild, and there are often no obvious symptoms in the early stages of the baby, but in the second half of the baby (6-12 months), there are some other symptoms:
1, can not turn over: 6 months later can not turn over, has a diagnostic significance.
2, do not use the lower limbs: 6-7 months without the lower limbs to support the weight briefly.
3, do not have one hand: 7-10 months of babies do not have to play with one hand.
4, hand stupid: the fine movements of the hand, such as pinching small things, unbuttoning, the belt is not flexible, uncoordinated, appeared in 7-10 months, has diagnostic significance.
5, can not sit alone: 7 months can not sit alone.
6, can not catch the station: 10 months can not catch the station.
7, will not be goodbye: 10 months later has a diagnostic significance.
8. Stand on tiptoe: Stand on tiptoe for 10 months.
9, can not take a step: 13-15 months later, will not take a step.
10, drooling and "eat hands": 12 months later has diagnostic value.
Examine
Pediatric cerebral palsy examination
Pediatric cerebral palsy needs to do the following checks:
1. Electrophysiological testing:
1 electroencephalogram (EEG): about 80% of children with cerebral palsy have abnormal brain waves, of which the rate of abnormal EEG is high, it may be normal, and it can also show abnormal background activity, accompanied by epileptic discharge wave Pay attention to the possibility of combining epilepsy.
2 EEG topographic map (BEAM): detection of brain development and brain wave changes in children.
3 magnetoencephalography.
4 evoked potential: visual acuity or hearing evoked potential examination can be given to patients with visual loss or hearing impairment.
5 EMG: To understand the functional status of muscles and nerves, children with cerebral palsy and muscle atrophy should do this as much as possible.
6 brain impedance blood flow map (REG): check the vascular function and blood supply of the head.
2, head CT, MRI, 1/2-2/3 children may have abnormalities, but normal can not deny the diagnosis of this disease, most cerebral palsy patients can find brain atrophy, external hydrocephalus, brain softening or brain Through the deformity.
Diagnosis
Diagnosis and diagnosis of cerebral palsy
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Cerebral palsy syndrome often needs to be differentiated from the following diseases:
1. Autism: Some children with autism use the tiptoe to walk on the ground, sometimes mistaken for cerebral palsy, but physical examination can find that Achilles tendon does not contract, foot dorsiflexion is unobstructed, sputum reflex is not hyperthyroidism, no pathological reflex, these characteristics are Can be identified with cerebral palsy.
2, congenital ligament relaxation: the main manifestations of this disease is the development of large sports, especially walking alone delay, unstable, easy to fall, up and down the stairs, sometimes mistaken for cerebral palsy, but the disease is mainly characterized by joint activities Significantly increased range, overextension, flexion, internal rotation or external rotation, normal muscle strength, normal sputum reflex, no pathological reflex, no mental retardation or convulsions, sometimes family history, gradually improved with age.
3, trisomy syndrome: 21 trisomy syndrome, also known as congenital, Down syndrome, is the most common autosomal disease, according to its special face and abnormal signs are generally not difficult to diagnose, but some cases of neonatal period symptoms are not Obviously, only the performance is reduced, the face is expressionless, there is no interest in the surrounding, the muscle tension is obviously low, the muscle strength is weakened, and sometimes it can be mistaken for the cerebral palsy muscle tension, but the knee reflex is weak or difficult to lead out. This is with the cerebral palsy. The obvious difference, and the Moro reflex is weakened or can not be revealed, the chromosome can be diagnosed when the disease is diagnosed.
4, metachromatic leukodystrophy: the disease is also known as cerebroside sulfate deposition disease, the child is manifested by the apparent low muscle tone at birth, with the development of the disease gradually appear quadriplegia, increased muscle tone, convulsions, mutual aid Disorders, progressive decline in intelligence, etc., the main point of identification of the base and cerebral palsy is that the condition is progressive development, and the activity of aromatic sulphate A in serum, urine or peripheral blood leukocytes can be confirmed.
5, GM1 gangliosides disease: GM1 gangliosides disease is divided into three types, type I (infant type) is a systemic GMl deposition disease, after birth, there is low muscle tone, sucking weakness, poor motor development, late Increased muscle tone, showing a state of brain rigidity, sometimes mixed with cerebral palsy, but the disease progresses rapidly, and has a special appearance, showing forehead protrusion, nasal bridge depression, low ear, large tongue, long middle, facial hairy The sick child is stunted, unable to watch, has nystagmus, hypersensitivity, shocking reflexes, and severe convulsions in the early stage. In about 1 to 2 months, the sick child has cherry red spots in the macula of the retina, and the liver and spleen appear after 6 months. It is swollen, the back of the spine is bent, the joints are contracted, and the brain is in a state of tonicity in the late stage. The reaction to the outside world disappears and most of them die within 2 years of age. GM1 ganglioside type II only invades the nervous system, may have poor motor development, unstable walking, hyperreflexia, sometimes need to be differentiated from cerebral palsy, but the disease starts in infants and young children, and the disease develops normally before the disease. Significantly different from the course of cerebral palsy, the disease often shows hypersensitivity, increased scare reflex, more mental retardation and convulsions, but this type has no special appearance, liver and spleen is not swollen, eye retinal macular no cherry red dot.
6, infant progressive spinal muscular atrophy: progressive spinal muscular atrophy in infants onset, muscle weakness is progressively aggravated, muscle atrophy is obvious, tendon reflex decline or disappear, commonly used respiratory muscle dysfunction and repeated respiratory infections Muscle biopsy can help diagnose the diagnosis.
