Difficulty turning over

Introduction Central dyskinesia is one of the clinical symptoms of cerebral palsy in children. It is characterized by retarded exercise, which is significantly behind the children of the same age. The child has difficulty in raising, turning and sitting. In recent years, the causes of cerebral palsy have been further explored at home and abroad. It is agreed that the abnormal development of early embryonic stage is likely to be an important cause of premature birth, low birth weight and perinatal hypoxia-ischemia. . This developmental abnormality in the early stage of the embryo mainly comes from the internal and external environmental effects of pregnant women before and after conception, genetic factors and pregnancy-induced disease, which cause placental amnion inflammation in early pregnancy.

Cause

Over the years, many perinatal risk factors have been implicated in the development of cerebral palsy, including: preterm birth and low birth weight, cerebral hypoxia-ischemia, birth trauma, congenital brain development, nuclear jaundice and congenital infections.

There have been literatures that summarize the causes of cerebral palsy, including: parental smoking, alcohol abuse, drug abuse, maternal psychosis, diabetes during pregnancy, vaginal bleeding, pregnancy-induced hypertension syndrome, placenta previa, threatened abortion or contraceptives , treatment of infertility drugs, pregnancy-preserving drugs, etc.; high birth times, high pregnancy times, history of stillbirth, premature birth, abortion history, twin or multiple births, fetal growth retardation, intrauterine infection, intrauterine distress, placental abruption Placental dysfunction, severe pregnancy response, umbilical cord around the neck, emergency production, inappropriate midwifery, delivery forceps delivery, breech delivery, long labor, premature or expired low birth weight infants, postnatal asphyxia, aspiration pneumonia, lack Oxygen ischemic encephalopathy, delayed cerebral jaundice or jaundice, intracranial hemorrhage, head trauma, convulsions, infection, poisoning and malnutrition.

an examination

Related inspection

Amniotic fluid alpha-fetoprotein assay (AFP) EEG examination

First, physical examination

Clinically characterized by abnormal posture and muscle tone, muscle weakness, involuntary movement and ataxia, often accompanied by sensation, cognition, communication, behavior and other disorders and secondary skeletal muscle abnormalities, and may have seizures.

Second, auxiliary inspection

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.

Differential diagnosis

Cerebral palsy syndrome often needs to be differentiated from the following diseases:

1. Autism: Some autistic children use the tiptoe when walking, sometimes mistaken for cerebral palsy. However, the physical examination can be found that the Achilles tendon does not contract, the dorsiflexion is unobstructed, the sputum reflex is not hyperthyroidism, and there is no pathological reflex. These characteristics can be distinguished from the cerebral palsy.

2, congenital ligament relaxation: the main manifestation of this disease is the development of large sports, especially walking alone, delay, easy to fall, easy to fall, up and down the stairs. Sometimes mistaken for cerebral palsy, but the disease is mainly characterized by a marked increase in the range of joint activity, excessive extension, flexion, internal rotation or external rotation, normal muscle strength, normal sputum reflex, no pathological reflex, without mental retardation or convulsions . Sometimes there is a family history. Symptoms gradually improve with age.

3, trisomy syndrome: 21 trisomy syndrome, also known as congenital, Down syndrome, is the most common autosomal disease. According to its special face and abnormal signs, it is not difficult to diagnose. However, in some cases, the symptoms are not obvious in the neonatal period, only the activity is reduced, the face is expressionless, there is no interest in the surrounding, the muscle tension is obviously low, the muscle strength is weakened, and sometimes the cerebral palsy muscle tension is low, but the knee reflex is weakened. Or difficult to lead, this is a distinct difference from the cerebral palsy, and the Moro reflection is weak or inconsistible. The chromosome can be checked by confirming the disease.

4, metachromatic leukodystrophy: the disease is also known as cerebroside sulfate deposition disease. When the child is born, the patient has obvious low muscle tone. With the development of the disease, quadriplegia, increased muscle tone, convulsions, ataxia, and progressive decline in intelligence appear. The main point of identification between basal and cerebral palsy is the progressive development of the disease. The detection of the activity of aromatic sulphate A in serum, urine or peripheral blood leukocytes can be confirmed.

5, GM1 gangliosides disease: the disease is divided into three types, type I (infant type) is a systemic GMl deposition disease, after birth, there is low muscle tone, sucking weakness, poor motor development, late muscle tension, showing The brain is stiff and sometimes mixed with the cerebral palsy. However, the disease progresses rapidly and has a special appearance, which is characterized by prominent forehead, nasal bridge depression, low ear position, large tongue, long middle, hairy face, slow development of sick children, inability to watch, nystagmus, hypersensitivity, fright The reflection is obvious. Severe convulsions occurred in the early stage, and the sick children had cherry red spots in the macula of the retina about 1 to 2 months. Hepatosplenomegaly appeared after 6 months, the spine was bent, and the joint contracted. In the late stage, the brain went to a state of rigidity, and the reaction to the outside disappeared, and most of them died within 2 years of age.

GM1 ganglioside type II only invades the nervous system, and may have backward motor development, unstable walking, hyperreflexia, and sometimes need to be differentiated from cerebral palsy. However, the disease starts in infants and children, and the disease develops normally before the disease. This point is significantly different from the course of cerebral palsy. The disease often shows hypersensitivity, increased scare reflex, and more mental retardation and convulsions, but this type has no special appearance, the liver and spleen are not swollen, and the retinal macula has no cherry red spots.

6, infant progressive spinal muscular atrophy: progressive spinal muscular atrophy in infants onset, muscle weakness is progressively aggravated, muscle atrophy is obvious, tendon reflex decline or disappear, commonly used respiratory muscle dysfunction and repeated respiratory infections Muscle biopsy can help diagnose the diagnosis.

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