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Cerebral palsy (CP)
Cerebral palsy is a permanent disorder of movement and posture caused by a non-progressive injury to the developing brain; the spastic type is the most common, and the "map" of the injury predicts the pattern — PVL in a preterm infant gives diplegia, a perinatal stroke gives hemiplegia.
Why it matters in the exam
Questions ask you to link the birth story to the type of palsy: a preterm infant with PVL — spastic diplegia (legs more than arms); an infant with a hand preference before one year — hemiplegia from a perinatal stroke; severe HIE in a term infant — quadriplegia; kernicterus or basal ganglia injury — dyskinetic CP (choreoathetosis); cerebellar injury — ataxic CP. Early hand preference is always a warning sign.
An important exam point: most cases of CP are not caused by birth asphyxia; they are linked to prematurity, infection, stroke and malformations. Early diagnosis is possible before 6 months corrected age by combining MRI, a structured neurological examination (HINE) and the General Movements Assessment (GMA). A child with "CP" who loses skills does not have CP — it is a progressive, metabolic or degenerative disease that must be investigated.
Treatment is multidisciplinary: physiotherapy and occupational therapy, orthoses, botulinum toxin for focal spasticity, oral or intrathecal baclofen for generalised spasticity, and selective dorsal rhizotomy in selected children with diplegia. GMFCS grades motor function from I (walks without limitation) to V (transported in a wheelchair). Comorbidities: intellectual disability, epilepsy, visual and hearing problems, swallowing difficulty and undernutrition, constipation, osteopenia, scoliosis and hip dislocation — hence hip surveillance with X-rays.
Key points
- CP is a permanent movement disorder from a non-progressive injury to the developing brain.
- The spastic type is the most common.
- PVL → diplegia; perinatal stroke → hemiplegia; kernicterus → dyskinetic.
- Early diagnosis before 6 months corrected age with MRI, HINE and GMA.
- Multidisciplinary treatment and comorbidity surveillance, including the hips.
Summary table
| Type | Brain injury | Typical cause | Presentation |
|---|---|---|---|
| Spastic — diplegia | Periventricular white matter (PVL) | Prematurity | Legs more than arms, toe walking, "scissoring" |
| Spastic — hemiplegia | Cortex and subcortex on one side | Perinatal stroke | Hand preference before one year, arm and leg on the same side |
| Spastic — quadriplegia | Extensive injury | Severe HIE, infection, malformations | All four limbs, intellectual disability and epilepsy common |
| Dyskinetic | Basal ganglia | Kernicterus, HIE in a term infant | Choreoathetosis, dystonia |
| Ataxic | Cerebellum | Malformations, genetic | Unsteadiness, intention tremor |
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Sources
- Novak I et al., Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment (JAMA Pediatrics), 2017 — Early diagnosis tools
- AACPDM Care Pathways: Hip Surveillance in Cerebral Palsy, 2017 (current) — Hip surveillance schedule
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Cerebral Palsy
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.