CEREBRAL PALSY

Fetal stroke

Cerebral Palsy is a congenital ischemic brain injury. It’s a baby stroke, in a way. But, the stroke usually isn’t caused by a clot, but rather from global hypoperfusion. Another term for this is a watershed stroke. In embryos, the vulnerable watershed zones happen to be bundles of myelin found near the ventricles. The myelin death can be spotted on an MRI, and is called periventricular leukomalacia. “Leuko” means white. “Mal” means bad. Dead myelin creates a vacuum, and due to its proximity to ventricles, the ischemic area can fill up with fluid and create a cyst.

What could cause an ischemic brain injury?

Usually prematurity. Half of CP patients are preterm deliveries. They’re brains are too underdeveloped to withstand even the slightest physical trauma or drop in BP. CP can be caused also by traumatic deliveries, genetics or toxins. 

What are the symptoms?

Bilateral spastic weakness, characterized by a scissor gait. Intellectual disability and ataxia are also common. 

Treatment?

Cerebral palsy is permanent, so treatment isn’t aimed to be curative. The goal is alleviation of symptoms. Treatment is multidisciplinary and involves neurologists, rehab, OT and speech therapy. To relieve muscle spasticity, Botox and muscle relaxers are given. When those no longer work, surgical cutting of muscles (myotomy), tendons (tenotomy) or nerve roots (rhizotomy) is considered.