Ataxia cerebral palsy
Introduction
Introduction to ataxia type cerebral palsy Ataxia-type cerebral palsy, also known as cerebral palsy, refers to a syndrome caused by non-progressive brain injury caused by some reasons before, during, and early babies. It is mainly characterized by central dyskinesia and abnormal posture. There are intelligent backwardness and seizures, abnormal behavior, sensory disturbances and other abnormalities. There are two types of mixed cerebral palsy with simple ataxia-type cerebral palsy, combined with spastic cerebral palsy and cerebral palsy. The major ataxia-type lesions in the cerebellum and its pathways are more common in sequelae of hydrocephalus, craniocerebral trauma, encephalitis or cerebellar tumors. Simple ataxia is rare. Cerebral palsy, which is mainly characterized by ataxia, accounts for about 5% of the total. Uncoordinated movement due to movement sensation and balance of sensation, manifested as low muscle contraction, slow muscle contraction, and low orientation and positioning ability. And the muscle contraction is not accurate, so it can't move correctly. basic knowledge The proportion of illness: 0.001% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: epilepsy
Cause
Ataxia cerebral palsy
Cause:
First, fetal intrauterine chronic hypoxia:
Pregnancy ischemia and hypoxia are important risk factors for cerebral palsy in children. Such as: pregnancy-induced hypertension syndrome, eclampsia, severe anemia, various heart, lung, liver, kidney disease, diabetes and infections affecting placental perfusion may lead to intrauterine chronic hypoxia.
Second, acute fetal intrauterine hypoxia:
Mainly refers to neonatal asphyxia caused by acute hypoxia during childbirth. Common causes are abnormal productivity, abnormal umbilical cord (the umbilical cord is too long or too short, knotting, entanglement, prolapse, distortion, and abnormal umbilical cord attachment), dystocia, emergency, ectopic, abnormal first exposure, internal reversal , forceps, fetal suction midwifery, head basin small name and oxytocin, painkillers and the use of anesthesia drugs, etc., may cause cerebral palsy in children.
Third, premature infants, low birth weight infants, expired births, giant children and twin or more fetuses, etc.:
Postpartum factors neonatal hypoxic ischemic encephalopathy, convulsions, trauma, intracranial hemorrhage, respiratory distress syndrome, hyperbilirubinemia, hypoglycemia, inhalation inflammation, sepsis, meningitis and other infectious diseases and fetus Heart and lung dysplasia caused by neonatal respiratory disorders are significantly associated with cerebral palsy in spastic children.
Fourth, other:
Neonatal hypoxic ischemic encephalopathy, convulsions, trauma, intracranial hemorrhage, respiratory distress syndrome, hyperbilirubinemia, hypoglycemia, aspiration pneumonia, sepsis, meningitis and other infectious diseases and fetal heart and lung Neonatal respiratory disorders caused by dysplasia are significantly associated with cerebral palsy in children.
Prevention
Ataxia cerebral palsy prevention
Prenatal prevention:
Actively carry out early prenatal diagnosis, fetal prediction, and carry out publicity and education on prenatal and postnatal care to improve the health of pregnant women and prevent congenital diseases. It is necessary to do an abortion to detect fetal abnormalities and prevent abnormal fetuses from being born. For the prevention of tremor cerebral palsy, in order to achieve the purpose of prenatal and postnatal care, do a good job in perinatal health care, pregnant women should pay attention to: avoid viral infections, such as flu, rubella and so on. Especially in the 10-18 weeks of pregnancy is a period of rapid development of the fetal nervous system, at this time should pay more attention to prevent infection. How to prevent dysfunction of cerebral palsy, especially anesthetics, sedatives, no smoking, drinking; avoid exposure to toxic and harmful substances and radiation, do not do too much B-ultrasound, it is best not to watch TV.
Prevention during birth:
Do a good job in the treatment of dystocia fetuses, improve the technical level of medical staff, and avoid damage to newborns during childbirth. This is a crucial part of preventing cerebral palsy. The relevant medical staff must be highly responsible for maternity, family and society, and carefully handle every aspect of childbirth. Once there is neonatal asphyxia, intracranial hemorrhage and other diseases, it is necessary to actively treat and reduce the damage to newborns.
Complication
Ataxia cerebral palsy complications Complications
1. Mental retardation: About 2/3 of the children are intelligently backward, about 1/4 are severely intelligent and backward, and those with quadriplegia and tonic cerebral palsy are often worse. It is rare for children with hand, foot and Xu-type to be seriously mentally retarded.
2. Visual impairment: About 25% to 50% of children with visual impairment, the most common are intraocular strabismus and refractive error, such as myopia, amblyopia, strabismus and so on. A few have nystagmus, and even blind. Patients with hemiplegia may have ipsilateral hemianopia. Visual defects can affect eye-hand coordination.
3. Hearing Impairment: About 25% of patients with hearing loss or even sputum are most common in children with neonatal bilirubinemia.
4. Sensory and cognitive abnormalities: children with cerebral palsy often have tactile, positional, physical sense, and two points of discrimination. The children lacked the correct visual space and stereoscopic feeling, and their cognitive function defects were more prominent. The children's recognition of complex graphics is poor, and the relationship between the shape of the object and the background of the space is not clear, and the recognition of the color is also poor.
5. Language barrier: About 1/3 to 2/3 children have different levels of language barriers. It is characterized by slow language development, difficult pronunciation, and unclear articulation. If you can't say a sentence, you can't express your meaning correctly. Some children are completely aphasia. Children with hand, foot, and ataxia are often accompanied by language disorders. Patients with spastic quadriplegia and bilateral spasticity are often accompanied by language disorders.
6. Seizures: At least 10% to 40% of children have seizures at different ages. It is more common in patients with quadriplegia, hemiplegia, single limb paralysis and mental retardation. Children with ataxia are rare.
7. Oral and dental dysfunction: About 25% of children with cerebral palsy are accompanied by sucking weakness, difficulty swallowing and chewing, poor lip closure, frequent drooling, and some caries or tooth dysplasia. These symptoms are caused by hand and foot. The most common children.
8. Emotional and behavioral disorders: Most children with cerebral palsy have emotional or behavioral abnormalities, which are associated with impaired brain function. A large number of experimental and clinical data indicate that the limbic system of the brain, especially when the hippocampus is damaged, can cause emotional abnormalities in the child. Children often show good crying, self-willedness, stubbornness, loneliness, temperament, fragile emotions, easy to be excited, and some have a sense of clarity, pleasure, and emotional instability. Children with hand and foot are more common. In addition, most children with cerebral palsy show excessive activity, distraction, and scattered behavior. Occasionally, the child slams the "forced" behavior of his own injury such as the head and jaw.
9. Bone and joint developmental malformations: The most common upper extremity deformities are: shoulder joint adduction, internal rotation, elbow flexion, forearm pronation, wrist flexion, thumb flexion or may be associated with adduction and finger flexion; Lower limb malformations include: pelvic tilt, acetabular dysplasia, hip dislocation or subluxation, hip adduction, hip flexion and internal rotation, knee flexion, knee varus, knee valgus, dislocation of the humerus or subluxation, and sagging of the foot. Foot valgus, foot varus, clubfoot deformity, claw toe deformity, and scoliosis and vertebral morphology abnormalities.
10. Others: Most children have poor physical development, malnutrition and low immune function, often suffering from respiratory infections. Children often have learning and social difficulties due to single or multiple defects such as physical movement, feeling, intelligence, language, mood, and behavior. Usually, dyskinesia in children with cerebral palsy interacts with the above-mentioned coexisting defects. Intelligent barriers aggravate language barriers, and various sensations, cognitive impairments, seizures, and learning difficulties increase mental retardation.
Symptom
Ataxia-type cerebral palsy symptoms common symptoms ataxia pediatric drooling eyeball tremor sensory ataxia gait expression apathy muscle tension reduction vestibular ataxia
Symptom characteristics
The major ataxia-type lesions in the cerebellum and its pathways are more common in sequelae of hydrocephalus, craniocerebral trauma, encephalitis or cerebellar tumors. Simple ataxia is rare. Cerebral palsy, which is mainly characterized by ataxia, accounts for about 5% of the total. Uncoordinated movement due to movement sensation and balance sensation, manifested as low muscle contraction, slow muscle contraction, low orientation and positioning ability, and inaccurate muscle contraction, which prevents correct movement.
The base of the walking step is wide, and the focus of the foot is often placed on the heel. The lumbar vertebrae are often overly curved. The trunk and the limbs are not coordinated. The left and right sides are swaying or tilting to one side, and cannot advance in a straight line. It is like a drink. Drunk gait. This gait is not much different when closing eyes, and the orientation of the hand is poor. It is difficult to complete the finger test and the knee test. The voice trembles with a facial expression indifferent and the facial muscles are stiffer. As the child grows up, the end of the town can become a little self-controlling by learning to limit his movements. Of course, the action will be dull and mechanical.
The Mutual Aid Movement is completed with the participation of the cerebral cortex cerebellum, vestibule, and deep sensory system. According to the different lesions, ataxia can be divided into cerebral ataxia, cerebellar ataxia, vestibular ataxia and sensory ataxia.
main performance
1. There is a significant delay in exercise development compared with children of the same age. The performance is awkward and uncoordinated, and the head and trunk are difficult to adjust. It will not sit around 1 year old, even if it is sitting. It is only possible to stabilize when the lower limbs flex, abduct, and support surfaces expand. Standing late, 2-3 years old or later, the child is unstable, easy to fall, fine finger movement disorder, inflexible movement.
2, intentional tremor and nystagmus, it is very difficult to pursue and purposefully grasp the object.
3, children often open their mouths, drooling, slow speech and unclear pronunciation, language barriers.
4, the child's muscle tension is low, but the tendon reflex is normal.
5, balance dysfunction, the center of gravity in the heel of the position, in order to maintain balance, the child often tilted the toes, increase the foot distance to expand the support area, bend forward to make up for the center of gravity.
Early symptoms
(1) Newborns or infants in March are prone to panic, crying, breastfeeding and difficulty sleeping.
(2) Early feeding, eating and chewing, drinking water, difficulty swallowing, and drooling and breathing disorders.
(3) The low sensory threshold is characterized by a change in noise or body position, and the hug reflection is enhanced with crying.
(4) Normal babies shortly after birth, due to the influence of step reflection, when the erect is erect, the two feet can be interactively moved. Although it can be dissipated at 3 months of age, but after 3 months, there is still no standing or stepping, and it is necessary to suspect children with cerebral palsy.
(5) The baby who has passed the "hundred days" can't look up, and the head is still swaying from April to May.
(6) Fist: In general, the baby can make a fist without opening within 3 months after birth. If the thumb is still adducted in 4 months, the cerebral palsy should be suspected if the hand is not open.
(7) Normal babies should see objects in March-May when they reach out. If they are not suspected to be pediatric cerebral palsy after 5 months.
(8) Generally, 4-6 weeks after birth, you will laugh and recognize people later. Children with sputum type cerebral palsy are indifferent, and the hands and feet are often sullen.
(9) The muscles are soft and cannot be turned over, and the movement is slow. When you touch the inside of the thigh of the child, or let the child's foot hit the bed or jump up and down, the lower extremity stretches.
(10) Stiffness, especially when dressing, the upper limb is difficult to wear into the cuff; when changing the diaper, the thigh is not easy to abduct; when rubbing the palm, and the limbs are stiff. Babies don't like the usual performance when taking a bath.
(11) Premature development: Children with cerebral palsy may have a premature turn over, but a sudden reflexive turn, the whole body turns like a rolling wood, rather than a conscious segmental turn. Infants with sputum sputum can appear stiff in both lower extremities before standing firmly, standing like a ballet dancer.
Examine
Ataxia type cerebral palsy examination
Imaging studies can provide evidence of brain pathological changes and contribute to the diagnosis and prognosis of cerebral palsy. Neonatal skull B ultrasound can be performed at the bedside, and it can easily detect lesions such as white matter softening and intracranial hemorrhage. Head MRI is superior to skull CT in displaying fine brain structural abnormalities, but head CT is more clear in showing calcification.
Epileptic authors need to do an EEG examination. Visual and auditory evoked potentials and hearing tests can be performed for those suspected of having visual and auditory impairment.
Need to exclude innate metabolic defects need to do blood / urine amino acid and organic acid analysis. Enzymology and genetic testing can exclude the corresponding brain degenerative diseases.
Diagnosis
Diagnosis and identification of ataxia-type cerebral palsy
Early diagnosis
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).)
1. The body is weak and spontaneous exercise is reduced. This is a symptom of low muscle tone, which 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 symptom of hypertonic muscle, which can be seen in one month. If it lasts for more than 4 months, it can be diagnosed as cerebral palsy.
3. Unresponsiveness and no response, this is an early manifestation of mental retardation. It is generally considered to be unresponsive at 4 months and no response at 6 months. It can be diagnosed as mental retardation.
4. Head circumference abnormality: head circumference is an objective indicator of brain shape development, and brain injury children often have head circumference abnormalities.
5. Poor weight gain and breastfeeding weakness.
6. Fixed posture, often caused by abnormal brain muscles caused by brain damage, such as angular arch reversal, frog position, inverted U-shaped posture. It can be seen in one month after birth.
7. Do not laugh: If you can't smile for 2 months, you can't laugh out loud for 4 months, you can diagnose it as mental retardation.
8. Hand fist: If you can't open it in 4 months, or the thumb is inward, especially the presence of one side of the upper limb, it has important diagnostic significance.
9. Body twist: If the baby is 3-4 months old, it often indicates extrapyramidal injury.
10. Head instability: If you can't raise your head or sit in a position for 4 months, you can't stand upright, which is often an important sign of brain damage.
11. Strabismus: 3-4 months of babies with strabismus and poor eye movements may indicate the presence of brain damage.
12. Can not reach out and grasp the object: If you can't reach out and grab the object in 4-5 months, you can diagnose it as mental retardation or cerebral palsy.
13. Gazing at the hand: It still exists after 6 months, and can be considered as mental retardation. 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).
