<aside> 🧠 Type of CP based on etiology:

• Kernictrus usually lead to athetoid (dyskinetic) CP
• Neonatal stroke will lead to double hemiplegic CP
• Meningiomylocele will lead to paraplegia
• Preterm babies tens to have diplegia </aside>

<aside> 🐣 Cerebral palsy is a nonprogressive neurologic injury that most commonly presents with delayed gross motor milestones, spasticity, and hyperreflexia. Premature infants are particularly susceptible due to periventricular leukomalacia (white matter necrosis).

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• CP is a non-progressive neurologic injury that causes motor dysfunction.
  • Spastic CP is the most common subtype and can affect the bilateral lower extremities (diplegia), unilateral arm and leg (hemiplegia), or in more severe cases, all four extremities (quadriplegia).
  • Kernicterus is associated with the athetoid (dyskinetic) CP subtype and hearing loss
• CP is more common in premature and low birthweight infants because they are susceptible to white matter loss (ie, periventricular leukomalacia) around the lateral ventricles.
  • In preterm babies there is high incidence of interventricular hemorrhage
    • Blood vessels supply the lower limbs are in close proximity to the ventricles
    • For this reason, preterm babies are more likely to have diplegia (LL > UL)
• Prematurity is the strongest risk factor for CP, however hypoxia is the most common cause.
• Inducing hypothermia (body temperature 33C) can help reduce cerebral palsy
  • Hypothermia reduces metabolic energy requirement and also decreases oxidative stress and inflammation

• In contrast to term infants, in whom watershed injury of the cerebral cortex is more likely to occur with poor perfusion, premature infants have sparse vascularization of the periventricular cerebral white matter.
• Ischemia to this area disrupts normal myelination, leading to neuronal cell death and cystic necrosis.  In addition, prematurity is also associated with increased risk for intraventricular hemorrhage, which can further contribute to the development of CP.
• However, in some cases, no underlying cause is identified.
• Delayed gross motor milestones are often the first sign of CP in infancy. Early hand preference (age <1) is also common with spastic hemiplegia, ex: infant whose right hand remains fisted and unable to relax due to increased tone.

• Diplegia: paralysis in 4 limbs but lower limbs are affected more
• Monoplegia: paralysis of one limb only
• Quadriplegia: paralysis of all limbs equally
• Double hemiplegia: paralysis of 4 limbs but one side of the body is affected more and upper limbs are more affected than lower limbs
  • UL > LL on one side

• Certain subtypes (eg, spastic cerebral palsy) often manifest as delayed gross motor milestones and spasticity (eg, hypertonia, hyperreflexia).  Spastic cerebral palsy may be caused by white matter necrosis (seen in this patient as periventricular leukomalacia), which leads to a loss of descending inhibitory control from the upper motor neurons.  This results in muscle overactivity, leading to increased tone and hyperreflexia.