pediatric cerebral palsy
Introduction
Introduction to pediatric cerebral palsy Cerebral palsy (cerebralpalsy) is a non-progressive brain injury syndrome caused by various reasons from birth to birth within 1 month after birth. It is mainly characterized by central dyskinesia, abnormal muscle tone, abnormal posture and reflex. . And can be accompanied by epilepsy, mental retardation, language barriers, visual and auditory disorders. basic knowledge The proportion of illness: 0.002% Susceptible people: young children Mode of infection: non-infectious Complications: epilepsy, amblyopia
Cause
Pediatric cerebral palsy
Preterm birth factor (15%):
There are many causes of cerebral palsy, which can occur at birth or in the neonatal period before or after birth. Sometimes it is caused by many factors. About one third of the cases are still unable to find the cause after tracing. For many years, it has been thought that the main cause of cerebral palsy is due to premature birth, birth injury, perinatal asphyxia and nuclear jaundice, but not all of these causes have cerebral palsy, so these factors can only be regarded as likely to have cerebral palsy. Risk factors, Vojta has listed more than 40 risk factors for cerebral palsy, including almost all abnormalities in the perinatal and neonatal period.
Neonatal asphyxia (25%):
The pediatric nervous system delivered by most high-risk pregnancies is normal. The etiology of spastic cerebral palsy in other countries also shows that less than 10% of children with cerebral palsy have asphyxia during childbirth, and there are more studies to prove that Half of the cerebral palsy occurs in surviving high-risk premature infants, low birth weight infants. Therefore, in recent years, studies on the etiology of cerebral palsy have been transferred to the field of embryonic developmental biology.
Perinatal blood hypoxia (15%):
It is believed that abnormalities in the early development of these embryos are likely to be an important cause of premature birth, perinatal ischemia and hypoxia, and an important basis for cerebral palsy in high-risk neonatal survivors. These studies provide the causes of cerebral palsy and early intervention in the future. A new way.
Pathogenesis
Cerebral palsy is a syndrome that can be caused by a variety of causes. Pathological changes are related to the cause. Brain development disorders caused by various congenital causes often have varying degrees of cerebral cortical atrophy and ventricular enlargement, and may have neuronal cell loss. Glial cell hyperplasia, hypoxic encephalopathy in premature infants can cause subependymal hemorrhage, white matter around the ventricle, softening and degeneration, can have multiple necrotic or degenerative areas and cystic cavity formation, the inner fiber capsule dominates the nerve fiber area of the limb ( The pyramidal plexus is often involved. The sequelae of nuclear jaundice may have abnormal medullary symmetry. It is called marble state. In recent years, some cerebral palsy with epilepsy has been found. The brain tissue has sulcular dysplasia and cell migration. Early brain developmental disorders such as abnormalities and gray matter ectopic.
Prevention
Cerebral palsy prevention in children
For the cause of cerebral palsy can occur before birth, perinatal period and after birth, preventive measures should be throughout, key preventive measures: 1 intrauterine infection during pregnancy; 2 premature delivery; 3 multiple pregnancies; 4 low birth weight; 5 at birth or newborn Severe hypoxia, convulsions, hyperbilirubinemia and cerebral hemorrhage.
Strengthening early pregnancy care can avoid damage to embryonic development caused by various harmful factors; further improve obstetric techniques and reduce cerebral ischemia and hypoxia damage caused by birth injury and asphyxia. In addition, strengthen neonatal care and diseases, such as neonatal hypoglycemia, acidosis, jaundice, serious infections and other prevention and treatment.
Complication
Pediatric cerebral palsy complications Complications, epilepsy, amblyopia
Cerebral palsy is often accompanied by other disorders, such as mental retardation (30% to 50%), epilepsy (25% to 50%), abnormal vision such as strabismus, amblyopia, nystagmus (about 50%), hearing loss (10% ~ 15%) and language barriers, cognitive and behavioral abnormalities.
Cerebral palsy mental retardation: almost half of the intelligence is low (IQ is less than 70), l/4 is at the edge (IQ is between 70-89), and the remaining 1/4 is average (1Q is 90-109) or above average (IQ Above 110).
Cerebral palsy language disorder: manifested as unclear pronunciation, difficult to construct words, language expression disorders, and even aphasia. Cerebral palpitations and behavioral disorders: Many children with cerebral palsy have hyperactivity, emotional instability, autism (lonely) tendencies, restricted exercise, difficulty in IQ measurement, and poor life practice during development than healthy children, which naturally affects mental development.
Cerebral Palsy Epilepsy: In the complication of cerebral palsy, epilepsy is often noticed by various convulsions.
Cerebral Palsy Symptoms: 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 and cognitive impairments.
Symptom
Symptoms of cerebral palsy in children Symptoms Common gait instability Motor dysfunction Cerebellar ataxia Reflex stretch dance-like hand-foot-swing involuntary movement Limb tremor temperament Paraplegia period Torsional paraplegia gait
1. General performance
The clinical manifestations of cerebral palsy are diverse, mainly:
(1) Early performance:
1 Psychic symptoms: excessive irritability, often crying, it is difficult to fall asleep, violent reaction to sudden sounds and changes in body position, body shaking, crying like scare.
2 feeding difficulties: manifested as uncoordinated sucking and swallowing, and slow weight gain.
3 Difficulties in nursing: It is difficult to put the arm into the sleeve when dressing. It is difficult to separate the thigh when changing the diaper. When the foot touches the edge of the tub or the water surface during bathing, the baby's back is immediately stiff and arched, accompanied by crying.
(2) Motor dysfunction: all manifested as:
1 sports development backward: including gross movement or fine motor delay, active movement is reduced.
2 abnormal muscle tone: manifested as hypertonic muscle, muscle rigidity, low muscle tone and muscle tension are not coordinated.
3 abnormal posture: at rest, posture such as tension neck reflex posture, limb straight posture, horn arch reversal posture, hemiplegia posture; abnormal posture during activity such as dance-like hand-foot-swinging and twisting sputum, spastic paraplegia gait, cerebellar mutual aid Offset gait.
4 Abnormal reflection: the original reflection delay disappears, the protective reflection delays and the Vojta posture reflection pattern is abnormal. Vojta posture reflection includes traction reflection, lift reflection, Collin horizontal and vertical reflection, standing and inverted and oblique suspension reflection.
2. Classification
According to the scope and nature of cerebral palsy motor dysfunction, the classification is as follows:
(1) spasticity: the highest incidence rate, accounting for 60% to 70% of all patients, often mixed with other types of symptoms, lesions and pyramidal tract system, mainly manifested as central sputum, affected limb muscle tension Increased, limited limb activity, abnormal posture, deep sputum reflex, positive sputum sputum, still positive for pyramidal tract after 2 years old, increased flexor tone of upper limbs, adduction of shoulder joint, elbow joint, wrist joint and finger joint flexion In the supine position, the lower extremity knee joint, the hip joint is in a flexion posture; the head position is difficult to raise the head; when the seat is started, the head is tilted backward, and when the seat can be sitting later, the legs are difficult to straighten, the kyphosis is convex, and the lower limb is "W Shape; hips when standing, knees slightly bent, toes on the ground; walking when walking, scissor-like gait, according to the affected parts are further divided into 7 kinds:
Hemiplegia: refers to the involvement of one limb and trunk. The upper limbs are more affected than the lower limbs, the spontaneous movement of the temporal limbs is reduced, the walking is delayed, the hemiplegic gait, the affected limbs are on the ground, and about 1/3 of the children There were convulsions at the age of 1 to 2 years, and about 25% of the children had cognitive dysfunction and mental retardation.
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3 quadriplegia (quadriplegia): refers to the limbs and trunk are affected, the upper and lower limbs are similar in severity, is the most serious type of cerebral palsy, often associated with mental retardation, language disorders, visual abnormalities and seizures.
4 paraplegia (paraplegia): the lower limbs are obviously affected, the trunk and upper limbs are normal.
5 double hemiplegia (double hemiplegia): limbs involved, but the upper limbs are more inconsistent than the lower limbs or the degree of paralysis on the left and right sides.
6 triple limbs (triplegia): three limbs involved, mostly upper limbs plus lower limb paralysis.
7 single (monoplegia): single limb involvement, single sputum performance is mild, easy to misdiagnosis, if it occurs in non-profit, it is more likely to be misdiagnosed.
(2) athetic type of hand and foot: about 20% of the cerebral palsy, the main lesions in the extrapyramidal system, manifested as involuntary movements that are difficult to control with will, involuntary, inconsistent and ineffective movements when performing conscious movements Increased, these movements disappeared during sleep, and the muscle tension decreased, the head was weak, the feeding was difficult, and the tongue often protruded out of the mouth and rogue. After 1 year of age, the movement of the hands and feet gradually became obvious, and the mouth muscles showed significant language difficulties. The statement is vague, tone adjustment is also involved, usually no pyramidal sign, hand and foot cerebral palsy is not serious, and convulsions are rare. With the extensive development of perinatal care, this type is now rare.
(3) rigidity: This type is rarely seen, because the body muscle tension is significantly increased, the body is abnormally stiff, the movement is reduced, mainly for extrapyramidal symptoms, when the limbs are passively exercised, the active muscles and antagonist muscles There is continuous resistance, the muscle tension is increased in lead-tube or gear shape, and the sputum reflex is not hyperthyroidism, often accompanied by severe mental retardation.
(4) ataxia type (ataxia): can occur alone or in combination with other types, the main lesions in the cerebellum, clinical manifestations of gait instability, widened foot spacing when walking, limbs movements are not coordinated, upper limbs often have intentions Sexual tremor, rapid change in the movement of the movement, finger nose test is easy to error, muscle tension is low, this type is rare.
(5) Tremor type (tremor): This type is rare, manifested as limb tremor, mostly static tremor.
(6) Inferior muscle tone (atonia): manifested as low muscle tone, soft limbs in the limbs, and little autonomic movement. In the supine position, the extremities are abducted and externally rotated like a frog, in the prone position, the head Can not be lifted, often easy to mix with muscle relaxation caused by muscle disease, but low muscle tone can lead to sputum reflex, most cases in infants and young children after the conversion to sputum type or hand and foot Xu move type.
(7) Mixed type: The same child can express the symptoms of the above 2 to 3 types, and the sputum type and the hand and foot type are often affected at the same time, and a small number of sick children cannot be classified.
Examine
Examination of cerebral palsy in children
Laboratory inspection
1. Neonatal routine hematuria examination, biochemical electrolyte examination.
2. Mother and newborn blood type examination, bilirubin qualitative test, serum total bilirubin quantification.
3. Older maternal prenatal amniotic fluid genes, chromosomes, immunological examination.
Auxiliary inspection:
1. EEG: EEG in children with seizures can be seen with sharp waves, spikes, and slow-sounding waves; some children without seizures can also have epileptic discharges; individual children may have bilateral amplitude asymmetry .
2. Brain CT examination: visible brain atrophy, white matter softening lesion around the ventricle, multiple brain softening lesions and polycystic softening, may be associated with congenital cerebral perforation malformation, transparent septal dysplasia, cyst, ventricular enlargement, etc., CT examination Help explore the cause of cerebral palsy.
Diagnosis
Diagnosis and differentiation of cerebral palsy in children
Diagnostic criteria
If you have any of the following conditions, you should be highly alert to the possibility of cerebral palsy:
1 premature infants, low birth weight infants at birth, severe hypoxia at birth and neonatal period, convulsions, intracranial hemorrhage and bilirubin encephalopathy;
2 mental retardation, emotional instability and horror, etc., retarded exercise;
3 has a typical manifestation of increased muscle tone of the limbs and trunk and sputum;
4 extrapyramidal symptoms with bilateral deafness and upper paralysis.
Differential diagnosis
It is differentiated from central sputum caused by progressive disease and transient dysplasia of normal children.
1. Simple hereditary spastic paraplegia: family history, childhood onset, slow progress, manifested as increased muscle tension in both lower limbs, hyperreflexia, may have arched foot deformity.
2. Complex hereditary spastic paraplegia: autosomal recessive genetic disease, the disease progresses rapidly, may have the above-mentioned double lower limb pyramidal tract sign, optic atrophy, sphincter dysfunction, etc., such as Behr syndrome.
3. Ataxia telangiectasia: also known as Louis-Barr syndrome, autosomal recessive inheritance, in a progressive course, in addition to ataxia, extrapyramidal symptoms, there may be conjunctival telangiectasia, a fetus Significantly increased protein and other characteristic manifestations, low immune function often accompanied by bronchitis and pneumonia.
4. Intracranial space-occupying lesions: such as headache, vomiting and optic disc edema, such as increased intracranial pressure, may have local signs, CT / MRI can be identified; encephalitis sequelae have a history of encephalitis, mental decline, irritability, excitement, Agitation and seizures.
5. Infant muscular dystrophy, glycogen storage disease, etc. may have progressive muscular atrophy and muscle weakness, progressive muscular atrophy with tongue hypertrophy, liver and spleen and heart enlargement should consider glycogen storage disease.
