Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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.