Spastic cerebral palsy

Introduction to spastic cerebral palsy Spastic cerebral palsy (hereinafter referred to as cerebral palsy), or cerebral palsy, refers to movement and posture disorders caused by non-progressive damage caused by immature brain under various causes of hypoplasia. Some lesions of the upper cervical cord that occur below the pyramidal cross are not consistent with the definition of the disease, but can still be treated with cerebral palsy. In the United States, cerebral palsy patients are the largest group of pediatric patients with neuromuscular disorders, different countries. The incidence of cerebral palsy in the region can vary from 6 to 59 per 1,000 newborns. The incidence increases with prenatal care, socioeconomic conditions, the environment, and improved obstetric and pediatric care for mothers and babies. In the United States, approximately 25,000 cerebral palsy patients are added each year. It can be speculated that a wide range of neonatal care institutions are saving more babies with prenatal or prenatal deficiencies than ever before, so the number of cerebral palsy patients has increased year by year. basic knowledge The proportion of illness: 0.078% (probability of illness in infants and young children) Susceptible people: infants and young children Mode of infection: non-infectious Complications: Asthma Urinary retention Urinary incontinence

Causes of spastic cerebral palsy

(1) Causes of the disease

Cerebral palsy can be caused by various factors such as prenatal, postpartum and postpartum. Prenatal refers to the period from pregnancy to childbirth. The time of birth refers to the delivery from the time of delivery to the delivery of the baby. Postpartum refers to the baby's brain from postpartum to 2.5 to 3 years after delivery. Completely developed, myelin formation can reach 8 years old. Some scholars believe that the birth time should be from the beginning of childbirth to 7 days after birth. At this stage, the baby body has been balanced with the external environment, and most of the cerebral palsy occurs in the mid-production.

(two) pathogenesis

Prenatal

Congenital defects in the brain, often caused by rubella or other viral infections in the first trimester of pregnancy, these children often have other congenital abnormalities, such as cataracts, congenital heart defects (ventricular septum) Defects, deafness and unresponsiveness, fetal erythrocytosis was a common prenatal cause. Prenatal antenatal hypoxia is mainly caused by placental rupture, placental infarction, maternal pneumonia or heart disease, mother drinking and taking drugs. The incidence of cerebral palsy is significantly increased, the mother has diabetes, and thyroid dysfunction is also the prenatal cause of cerebral palsy. If the child has cerebral palsy, it may be congenital, such as hydrocephalus and microcephaly, which is not Prenatal factors.

2. Time of birth

The most common cause of birth is premature birth. If the body weight is less than 2268g at birth, there are many opportunities for cerebral palsy. Others are usually caused by improper application of forceps, dystocia or prolonged labor, resulting in trauma or hypoxia during childbirth. Traction of the fetal neck can cause the large vein of Galen to break, leading to hemiplegia or quadriplegia. Local trauma can cause spasmodic hemiplegia. For example, the fetal head hits the humeral condyle during dystocia, and the fetus can be hemiplegic during maternal convulsion.

3. Postpartum

The most common causes of cerebral palsy in the postpartum period are encephalitis, meningitis, trauma, vascular accidents and hypoxia. In the acute phase of encephalitis, motor function defects progress as the lesions intensify. In the later stages of the acute phase, scars in the brain tissue increase. At present, the number of cases of cerebral palsy caused by infection is significantly reduced; head trauma is mainly caused by car accidents and child abuse, which is a cause of more morbidity in postpartum cerebral palsy; children may be deficient in water due to sputum, fibroblasts Sexual disorders and other sports disorders, such as chorea and acromegaly, traumatic cerebral palsy or accompanied by bleeding is usually paralyzed; neurological disorders caused by hypoxia and trauma continue to improve over time, most One year after the injury, Brink and Hoffer's study of children with traumatic brain injury showed that the recovery was directly related to the plane and duration of the coma after the initial injury. If the coma was deep for more than 1 week, the recovery rate was lower.

Spastic cerebral palsy prevention

First, the child is born before the birth: pregnant women should actively carry out early prenatal examination, do a good job in perinatal care to prevent congenital diseases in the fetus; should quit bad habits, such as smoking, drinking, can not abuse drugs such as anesthetics, sedatives; prevention Infected with flu, rubella and other viruses, do not touch cats, dogs, etc.; avoid contact with harmful and toxic substances such as radiation and frequent B-ultrasound.

Second, when the baby is born, that is, during childbirth. Fetal asphyxia and intracranial hemorrhage caused by childbirth are an important cause of spastic cerebral palsy. Premature birth and dystocia should be prevented. Medical staff should carefully handle all aspects of childbirth and do a good job in the treatment of dystocia.

Third, the fetus should strengthen nursing and reasonable feeding within one month after birth, and prevent intracranial infection and brain trauma.

Spastic cerebral palsy complications Complications, asthma, urinary retention, incontinence

Surgical complications

Surgery should use microsurgical techniques and fine techniques and operations to reduce various side injuries; rough methods should be avoided to cause unnecessary damage due to excessive pulling. It is very important to carefully control the bleeding during the operation. Pay special attention to ensure that the blood volume of the relatively bloodless field should be controlled within 50~100ml. Try to avoid blood flowing into the dura mater to reduce the occurrence of postoperative cauda equina adhesion. The ratio of the posterior root fiber cutting avoids the weakness of the muscles due to the reduction of muscle tension and the weakness of the limbs. The anterior and posterior roots should be carefully discriminated. Avoiding the cutting of the anterior root and causing soft sputum retention and urinary incontinence are mostly temporary. Should be avoided as much as possible, due to the traction of 2 nerve roots should pay attention to retain small joints in laminectomy, maintain the stability of the spine, children need to pay special attention to the presence or absence of laryngeal edema after general anesthesia Care should be taken to prevent suffocation due to asthma attacks after surgery.

Symptoms of spastic cerebral palsy common symptoms bedridden single sputum reflex hyperthyroidism myoclonus palsy reaction slow trauma ataxia mental disorder meningitis

The location of the brain lesion determines the clinical type of cerebral palsy. For example, cerebral cortex injury can usually cause sputum or lack of exercise. The majority of damage is not limited to the area of a certain muscle that is dominated by the brain. The entire body part that governs is affected, which is why the entire limb is affected to varying degrees, unlike polio, which only affects a muscle type. If a muscle is significantly affected, consider other muscles in this area. There are different degrees of embarrassment.

1. Classification by clinical performance

(1) sputum type cerebral palsy: the most common, accounting for about 55%, the Brodman IV area and the VI area of the brain are the starting parts of the pyramidal tract, and the lesions in these two areas are commonly called pyramidal tract diseases, usually causing sputum, sputum The state is a state in which the intramuscular tension increases when the muscle is passively stretched, which is caused by the strengthening of the normal muscle stretch reflex. In the enhanced stretch reflex, the muscle can feel the resistance when it is suddenly passively active. Then, to a certain extent, the muscles are slack. When the muscles are stretched, the increase of the sputum state will cause excessive contraction of the muscles, and the tendon reflexes of the tendon muscles may increase, and muscle fibrillation may occur, which indicates an increase in the response to the drafting.

(2) Hand and foot Xudong type: Hand and foot hyperactivity disorder accounts for about 25% of cerebral palsy patients, which is the most common form of dyskinesia cerebral palsy. The lesion causing dyskinesia is in the brain base or in the midbrain, often involving the whole The body, rarely seeing a movement disorder of the limbs, patients often accompanied by facial muscles and muscle lesions that control language, manifested as persistent painful facial expressions, drooling, difficulty speaking, leading to people mistakenly thinking that these people are unresponsive, and the facts Many patients have normal intelligence.

(3) Stiff type: stiff cerebral palsy accounts for about 3% to 5%, which is a manifestation of extensive brain injury. The clinical manifestation of cerebral palsy is the loss of muscle elasticity. When attempting to stretch muscles, the examiner passively moves from the joint. From the beginning to the end, the patient's muscle stiffness is detected. The passive active joint can aggravate the stretch reflex. In the stiff type of the cerebral palsy, the patient's muscle rigidity can be intermittent or persistent. Due to the diffuse damage of the brain tissue, the incidence of mental disorder is quite high. .

(4) Ataxia type: Ataxia type accounts for about 5%, which is a clinical manifestation of cerebellar injury. Most of the damage caused by cerebellar lesions is congenital, and occasionally due to bleeding during childbirth, due to exercise, Spatial locating damage can not distinguish the afferent impulse and cause ataxia. The dissonance of mutual aid is mainly positional consciousness, posture and balance sensation loss. Children may have habits that are not completely fixed by hand. The typical ataxia patients are more likely. Other types of cerebral palsy patients have a better prognosis, and their symptoms have a spontaneous improvement trend over time.

(5) Mixed type: Mixed type accounts for about 10%. The damage originated from several areas of the brain exists at the same time, but it is not diffuse damage. The patient shows that several types of symptoms are mixed with each other, such as mixed with axillary type and ataxia type. Wait.

2. Classification according to the location of the disease

(1) Single sputum: Regardless of the upper limb or the lower limb, only one limb is affected, which is a rare type. Before making a diagnosis, the examiner must carefully assess the condition of other limbs.

(2) Hemiplegia: The ipsilateral limb is involved. These patients are usually spasmodic, and the upper limbs are usually more severe than the lower limbs.

(3) Paraplegia: often accompanied by premature delivery, paraplegia is mostly sputum type, manifested as scissors gait or cross gait.

(4) Three limb paralysis: three of the four limbs, the most common is spastic paralysis, is a relatively rare movement disorder. Before determining the three limb paralysis, it is necessary to carefully evaluate a limb that is not tired.

(5) Quadriplegia: Brain damage invades the limbs, and the limbs can be paralyzed, dyskinesia or mixed.

3. Classification according to the level of muscle tension and its severity

Cerebral palsy can be classified according to its muscle tone and severity of damage. Muscle tone can exhibit high tension, low tension or normal, muscle tension can be changed, and can change with time. Cerebral palsy with hand-foot-on-motion is born low. Tension, but gradually increases into high tension with age. On the other hand, children with ataxia are born with low tension and remain unchanged. The severity of the damage can be mild, moderate or severe, and mildly affected. Patients can get up and walk, and can carry out their daily activities independently. About 25% do not need any surgical treatment. Conservative treatments such as fine-motion training, vocational training, special education and speaking training are necessary. Moderate damage accounts for 50%, getting up. Both walking and daily life need help. Seriously damaging the patient is completely incapable of living. Usually, bedridden or wheelchair-dependent. Because it is impossible to improve the patient's mobility, the purpose of treatment is to improve the function of the activity instead of getting up. .

Examination of spastic cerebral palsy

Can do the examination of the nervous system and the examination of motor function.

Diagnosis and diagnosis of spastic cerebral palsy

According to maternal pregnancy, whether it is suffering from rubella or other viral infections in the first trimester, whether it is premature dystocia, whether it is encephalitis after birth, meningitis, traumatic hypoxia, comprehensive clinical manifestations are not difficult to diagnose.

diagnosis

It is difficult to diagnose the baby in the early stage, but it is very important in order to get early treatment. It is necessary to make a diagnosis within 6 months to 1 year old. First, ask the mother's pregnancy history and childbirth history in detail. Whether the newborn has a manifestation of exhalation or muscle twitching, and whether there is severe jaundice. If the above situation exists, even if the baby can be discharged on time, there is no abnormality in all aspects, and it cannot be regarded as sure that there is no problem. Must be followed for at least 18 months. If the baby is found to have stiff limbs or limited mobility, the legs cannot be separated or the muscle tension is reduced or lost when the diaper is changed, the limb arteries are excessive or not moving, and the baby is delayed in development, etc., and the disease must be suspected.

The basis for diagnosis is:

1 exercise development delay. Delayed motor development in infants with cerebral palsy is an important manifestation.

2 knee reflexes, sputum sputum, adductor tendon and so on. This is often found within a few weeks of birth.

3 If the baby is lifted up in the air and the abdomen is down, the normal baby will flex the elbow joint, extend the hip joint and bend the knee joint. However, children with cerebral palsy manifest as sagging limbs. This can be seen after 6 weeks of birth.

4 The neck is tough, and there is a grip or a hand that cannot be opened. This can occur after 3 months.

5 When the cubic object is given to the baby, the hand is opened slowly. This can happen after 6 months.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.