Plantar reflex

Introduction The sputum reflex is a symptom caused by cerebral palsy. More common in babies. Most children have an extensor response to sputum reflexes, only the initial clinical manifestations. Often due to the mother's pregnancy, she developed rubella and other viral infections, especially during the first 3 months of pregnancy. Often accompanied by other congenital anomalies such as cataracts, deafness, congenital heart disease. The cerebral vascular development of premature infants is incomplete and fragile. It is suddenly delivered from the higher pressure uterus to the extracorporeal air during childbirth. The pressure changes greatly and the blood vessels rupture. Premature infants are also particularly sensitive to asphyxia.

Cause

Any condition that can cause damage to brain tissue can be a causative factor.

First, prenatal factors: congenital brain dysplasia, often because the mother was born with rubella and other viral infections, especially in the first 3 months of pregnancy. Often accompanied by other congenital anomalies such as cataracts, deafness, congenital heart disease. Fetal erythrocytosis, which causes severe neonatal jaundice, can cause damage to the basal nucleus of the brain and the appearance of kerogram (kerikterus).

Second, the factors of birth time: including brain damage caused by birth injury and cerebral hypoxia, accounting for 37% of the cause of cerebral palsy. The use of forceps to pull the fetal head strongly can rupture the neck vein, causing intracranial hemorrhage. Cerebral hypoxia can be caused by inappropriate application of sedation or anesthetics in the second phase of the second stage of labor. The umbilical cord around the neck causes passive cerebral congestion. Long-term asphyxia and purpura after the delivery of the fetus are prone to cerebral palsy. Placental rupture and placenta previa can also cause fetal brain damage. Premature birth is prone to cerebral hemorrhage. This is because the cerebral vascular development of premature infants is incomplete and fragile. It is suddenly delivered from the higher pressure uterus to the extracorporeal air during childbirth. The pressure changes greatly and the blood vessels rupture. Premature infants are also particularly sensitive to asphyxia.

Third, postpartum factors: cerebral palsy caused by infectious encephalitis, often progressive. However, if it is secondary encephalitis or post-infectious encephalitis (such as vaginal encephalitis after measles), it is non-progressive, and most of it can be recovered by treatment. High heat cramps, etc., especially in the first few weeks after birth, often cause intracerebral hemorrhage. According to the etiology, the injury accounted for 13% during birth, 24% for hypoxia, 32% for premature birth, 11% for congenital defects, and 7% for postpartum. The patient's mother had a history of 1 to 5 abortions, accounting for 30%.

an examination

Related inspection

Brain CT examination of nervous system examination

Diagnosis: At present, there is a lack of specific diagnostic indicators for cerebral palsy, mainly based on clinical symptoms and signs. The three diagnostic criteria developed in China (1988) Pediatric Cerebral Palsy Conference are:

1 Central paralysis occurs in infancy.

2 with mental retardation, convulsions, abnormal behavior, sensory disturbances and other abnormalities.

3 Except for the progressive disease caused by central sputum and normal children with transient movement development. Be alert to the possibility of cerebral palsy if you have any of the following conditions.

1 premature infants, low birth weight infants at birth, severe hypoxia at birth and neonatal period, convulsions, intracranial hemorrhage and bilirubin encephalopathy.

2 mental retardation, emotional instability and easy to panic, etc., sports retardation.

3 There are limb and trunk muscle tension and typical performance of sputum.

4 extrapyramidal symptoms with bilateral deafness and upper paralysis.

Laboratory inspection:

1. Neonatal routine hematuria examination, biochemical electrolyte examination.

2. Mother and newborn blood type examination, bilirubin qualitative test, serum total bilirubin quantification.

3. Elderly maternal prenatal amniotic fluid gene, chromosome, immunological examination.

Other auxiliary inspections:

1. CT and MRI examination of the brain in children.

2. Pregnant women have regular prenatal checkups.

Differential diagnosis

Acute disseminated myelitis

The disease mostly occurs in young adults, and most of them have symptoms of sensation or vaccination for several days or 1-2 weeks before the disease. Cold, overwork, trauma, etc. are often the cause of the disease. The onset is urgent, the first symptoms are mostly numbness and weakness of the lower extremities, the corresponding parts of the lesions are painful, and the lesions have a sense of banding, which often reaches a peak within 2 to 3 days. Clinically, the main features of limb paralysis, sensory loss and sphincter disorders are below the level of lesions. The acute phase can manifest as spinal shock. There are many autonomic dysfunctions below the damage plane. The disease can enter the recovery period after 3 to 4 weeks, and most of them recover after 3 to 6 months after the onset. A few cases have different degrees of sequelae, but most of them are not accompanied by spastic paralysis, involuntary movement, and mental retardation. Seizures.

2. Optic neuromyelitis

The onset age of the disease is between 20 and 40 years old, and the incidence of under 10 years old is rare, which is a subtype of multiple sclerosis. Acute or subacute onset. First of all, the symptoms are mostly back pain or shoulder pain, followed by partial or complete spinal cord transverse damage, and can show visual acuity such as decreased vision before or after the symptoms of transverse spinal cord injury, but the condition is often relieved. Recurrence, but also other multifocal signs, such as nystagmus, diplopia, ataxia and so on.

3. Myasthenia gravis

The disease is more common than 20 to 60 years old, and children are less common. Insidious onset, the first symptoms are mostly different degrees of weakness of the extraocular muscles, including ptosis, limited eye movement and diplopia, other skeletal muscles can also be affected, such as masticatory muscles, throat muscles, facial muscles, sternocleidomastoid Muscle, trapezius and limb muscles can affect daily activities, and severe cases are forced to stay in bed. The above symptoms are usually aggravated after the activity, and can be relieved to varying degrees after rest, and have the characteristics of being light and heavy. Some cases have thymic hypertrophy or thymoma. Some merge with other autoimmune diseases such as hyperthyroidism.

4. Periodic paralysis

The disease is characterized by recurrent skeletal muscle flaccid paralysis, more than adolescent onset, and the onset is gradually reduced after middle age, and the incidence of infants and young children is extremely rare. Can be induced by factors such as overwork, full meal, cold, anxiety. Generally, more than the rest after a meal break or strenuous exercise, the onset of the disease, mostly from the lower limbs, and then the extension of the upper limbs, bilateral symmetry, with a proximal end heavier. The attack usually lasts for 6 to 24 hours, and the elderly can reach more than one week. Irregular recurrent episodes, most of which have changes in blood potassium (increased or decreased), some cases of heart rhythm disorder, blood pressure rises. Intermittent muscle strength during the interval. According to the seizure process, clinical signs, laboratory tests and family history, it is not difficult to identify this disease.

5. Progressive muscular dystrophy

The disease is a group of genetic diseases that originate in the muscles, mostly family history. The clinical features are characterized by symmetrical muscle weakness and muscle atrophy that slowly progress progressively. Individual types may have myocardial involvement. Different types often present with different ages of onset, clinical features, and diseased muscle distribution. But in general it is more common in children and adolescents. It can be seen that the "winged shoulders", "free shoulders", "calf muscle pseudo-hypertrophy", "Gowers" sign and other characteristic performance. With the progressive symptoms, age of onset, clinical features and family history can be identified with the disease.

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