Cerebral palsy is a spectrum of developmental disorders that result from a non-progressive insult to the developing brain in utero or early life. Characteristically, muscle tone and movement are affected but there is wide variation in the degree to which each individual is affected ¹.

Epidemiology

The incidence of cerebral palsy is approximately 2 per 1000 live births ².

Risk factors include:

• prematurity (particularly earlier than 32 weeks gestation)

• low birthweight (particularly <1500 g)

• infection during pregnancy

• intrapartum complications

• neonatal meningitis or head injury

Clinical presentation

The diagnosis is usually not made at birth but becomes apparent in early childhood due to delay in reaching developmental or motor milestones, such as difficulty walking or sitting. 

Classification is usually based on the characteristics of the symptoms:

• spastic: most common (80%), characterized by increased tone, and often qualified by the parts of the body affected

  • diplegic: affecting the lower limbs predominantly

  • hemiplegic: affecting the leg and arm on one side of the body, with the arm often less affected

  • quadriplegic: all four limbs affected, the most severe form, usually associated with developmental delay, seizures and other neurological sequelae

• ataxic: due to cerebellar involvement, characterized by difficulties with balance and coordination

• dyskinetic: characterized by random movements

However, such a classification system is a blunt tool and does not adequately capture the range of disability that might be experienced by each individual within each category. For this reason, functional classification systems such as the Gross Motor Function Classification System (GMFCS) are used to more usefully classify the functional ability of each individual ³.

Pathology

There is no single pathological manifestation of cerebral palsy, as many different insults to the developing brain can cause it. The insult to the brain is static but the manifestation of symptoms can change over time due to growth and development.

Radiographic features

Since there is no single pathological manifestation of cerebral palsy, the imaging appearances of the causative condition can be widely variable. 

Conditions that may manifest as causing cerebral palsy include:

• periventricular leukomalacia

• hypoxic ischemic encephalopathy

• neonatal stroke

Treatment and prognosis

This depends significantly on the severity of the condition, but since the insult to the brain is static, treatment is focused on managing the symptoms and multidisciplinary support for development.

History and etymology

Cerebral palsy was first studied by English physician William John Little (1810-1894), but the term was coined by Canadian physician Sir William Osler (1849-1919) in 1888 ⁴.