Cerebral palsy

What it is

Cerebral palsy (CP) is a chronic disorder of muscle tone and movement due to a non-progressive injury to the developing brain. It sits at the head of the causes of developmental delay.

Causes and risk

CP can result from a number of conditions that result in brain injury which particularly affects the motor areas of the brain. The events which lead to injury usually occur before, during or shortly after birth, but may be acquired at a later period following head trauma or meningitis. Most CP is due to brain injury which is acquired before birth.

The history therefore reaches back to the neonatal period: labour and delivery, the condition at birth, any need of ventilation or intensive care, sepsis and particularly meningitis, abnormal cranial US, and seizures. A family history of an inherited disorder matters too.

How it presents

Infants may be floppy at birth and develop neonatal seizures. The diagnosis, however, cannot be made at birth. CP characteristically presents with motor delay and muscle stiffness — hypertonia or spasticity which present in infancy.

The pattern of limbs affected carries its own name:

• If only the legs are affected, this is called diplegia.
• If the arm and leg on one side are affected, this is known as hemiplegia.
• If all four limbs are affected, the condition is known as quadriplegia.

On the developmental side there is poor head control at term and delayed developmental milestones — sucking, smiling, reaching for objects. Hearing loss and visual problems are part of the picture, including abnormal eye movements such as strabismus.