Cerebral Palsy (cont.)
What Are Cerebral Palsy Symptoms?
The signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child's nervous system matures. Early signs include the following:
- Delayed milestones such as controlling head, rolling over, reaching with one hand, sitting without support, crawling, or walking
- Persistence of "infantile" or "primitive reflexes," which normally disappear 3 to 6 months after birth
- Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side, which may be an early sign of CP.
Problems and disabilities related to CP range from very mild to very severe. Their severity is related to the severity of the brain damage. They may be very subtle, noticeable only to medical professionals, or may be obvious to the parents and other caregivers.
- Abnormal muscle tone: Muscles may be very stiff (spastic) or unusually relaxed and "floppy." Limbs may be held in unusual or awkward positions. For example, spastic leg muscles may cause legs to cross in a scissor-like position.
- Abnormal movements: Movements may be unusually jerky or abrupt, or slow and writhing. They may appear uncontrolled or without purpose.
- Skeletal deformities: People who have cerebral palsy on only one side may have shortened limbs on the affected side. If not corrected by surgery or a device, this can lead to tilting of the pelvic bones and scoliosis (curvature of the spine).
- Joint contractures: People with spastic cerebral palsy may develop severe stiffening of the joints because of unequal pressures on the joints exerted by muscles of differing tone or strength.
- Mental retardation: Some, although not all, children with cerebral palsy are affected by mental retardation. Generally, the more severe the retardation, the more severe the disability overall.
- Seizures: About one-third of people with cerebral palsy have seizures. Seizures may appear early in life or years after the brain damage that causes cerebral palsy. The physical signs of a seizure may be partly masked by the abnormal movements of a person with cerebral palsy.
- Speech problems: Speech is partly controlled by movements of muscles of the tongue, mouth, and throat. Some individuals with cerebral palsy are unable to control these muscles and thus cannot speak normally.
- Swallowing problems: Swallowing is a very complex function that requires precise interaction of many groups of muscles. People with cerebral palsy who are unable to control these muscles will have problems sucking, eating, drinking, and controlling their saliva. They may drool. An even greater risk is aspiration, the inhalation into the lungs of food or fluids from the mouth or nose. This can cause infection or even suffocation.
- Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. The child may not respond to sounds or may have delayed speech.
- Vision problems: Three-quarters of people with cerebral palsy have strabismus, which is the turning in or out of one eye. This is due to weakness of the muscles that control eye movement. These people are often nearsighted. If not corrected, strabismus can lead to more severe vision problems over time.
- Dental problems: People with cerebral palsy tend to have more cavities than usual. This results from both defects in tooth enamel and difficulties brushing the teeth.
- Bowel and/or bladder control problems: These are caused by lack of muscle control.
How to Test for Cerebral Palsy
If a child has problems that suggest cerebral palsy, he or she will undergo a very thorough evaluation. There is no medical test that confirms the diagnosis of cerebral palsy. The diagnosis is made on the basis of various types of information gathered by the child's health care professional and, in some cases, other consultants.
- This information includes a detailed medical interview concerning medical histories of both the mother's and father's families, the mother's medical problems before and during pregnancy, and a detailed account of the pregnancy, labor, delivery, and neonatal (newborn) period.
- Parents will be asked to relate in detail the child's medical problems and mental and physical development.
- Parents may be asked other questions as well. It is very important to answer all questions as completely and honestly as possible, as the answers may help the child.
Lab studies: Various blood and urine tests may be ordered if your child's health care professional suspects that the child's difficulties are due to chemical, hormonal, or metabolic problems. Analysis of the child’s chromosomes, including karyotype analysis and specific DNA testing, may be needed to rule out a genetic syndrome.
Imaging studies: These studies provide a picture of structures inside the body. Such testing, when used on the brain or spinal cord, is often called neuroimaging. These tests are not always necessary, but in many cases, they may help identify the cause or extent of the cerebral palsy. They should be done as early as possible so that appropriate treatment, if indicated, can be begun immediately. Many individuals with mild cerebral palsy have no visible brain abnormalities.
- Ultrasound of the brain: Ultrasound uses harmless sound waves to detect certain types of structural and anatomic abnormalities. For instance, it can show hemorrhage (bleeding) in the brain or damage caused by lack of oxygen to the brain. Ultrasound is often used on newborns who cannot tolerate more rigorous tests such as CT scans or MRI.
- CT scan of the brain: This scan is similar to an X-ray but shows greater detail and gives a more three-dimensional image. It identifies malformations, hemorrhage, and certain other abnormalities in infants more clearly than ultrasound.
- MRI of the brain: This is the preferred test, since it defines brain structures and abnormalities more clearly than any other method. Children who are unable to remain still for at least 45 minutes may require a sedative to undergo this test.
- MRI of the spinal cord: This may be necessary in children with spasticity of the legs and worsening of bowel and bladder function, which suggest an abnormality of the spinal cord. Such abnormalities may or may not be related to cerebral palsy.
Other tests: Under certain circumstances, a child's health care professional may want to do other tests.
- Electroencephalography (EEG) is important in the diagnosis of seizure disorders. A high index of suspicion is needed in order to detect nonconvulsive or minimally convulsive seizures. This is a potentially treatable cause of a CP-look-alike, which is easier to treat when treated early.
- Electromyography (EMG) and nerve conduction studies (NCS) may be helpful in distinguishing CP from other muscle or nerve disorders.
When to Seek Medical Care
If a child was born prematurely, had a low birth weight, or was subject to certain complications of pregnancy, labor, or delivery, he or she will be monitored carefully over time for signs of CP. Any of the following warrant a visit to the child's health care professional:
- The child has a seizure.
- The child's movements seem unusually jerky, abrupt, uncoordinated, or slow and writhing.
- The child's muscles seem unusually tense or, on the other hand, limp and "floppy."
- The child does not blink in response to loud noises by age 1 month.
- The child does not turn his or her head toward a sound by age 4 months.
- The child does not reach out for a toy by age 4 months.
- The child does not sit up unsupported by age 7 months.
- The child does not say words by age 12 months.
- The child develops left- or right-handedness before age 12 months.
- The child has strabismus (one eye turned inward or outward).
- The child does not walk or walks with a stiff or abnormal gait, such as toe-walking.
These are only some of the most obvious examples of problems that may signal CP. A parent should speak to the child's health care professional about any problems that suggest a lack of control of muscles or movements.
Medically Reviewed by a Doctor on 9/16/2016
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