Aside from events that occur prior to or around the time of birth, there are also postnatal factors that cause cerebral palsy. Contraction of an infection (such as meningitis), heavy exposure to a toxin (such as lead) and being violently shaken (i.e., shaken baby syndrome) as an infant, early on in development, can lead to cerebral palsy.
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AIM: To use the information from a population-based cerebral palsy register to describe post-neonatally acquired cerebral palsy, to determine trends over time and relate any aetiological trends to community preventative measures. METHODS: Data on cases of post-neonatally acquired cerebral palsy, between the birth years 1970 and 1999, were generated from the Victorian Cerebral Palsy Register. Distributions, rates and trends over time were calculated for the entire cohort and for subgroups according to gender, age at acquisition, aetiology, gestation at delivery, birthweight, maternal age at delivery and parity. RESULTS: 339 cases were found with post-neonatally acquired cerebral palsy, accounting for 10.7% of all cerebral palsy and giving an overall rate of 1.98/10 000 live births. There was a statistically significant fall in the overall rate of post-neonatally acquired cerebral palsy (P = 0.001) over the study period. Significant falls were seen in post-neonatal cerebral palsy due to infection, traumatic head injury and hypoxia and other acute encephalopathies, but not cerebrovascular accidents. CONCLUSION: A large proportion of post-neonatally acquired cerebral palsy is preventable. While the reported decline in cases in Victoria is encouraging, it will be important to monitor these trends over time, and continue public health measures to further reduce preventable causes.
[Reid, S. M., Lanigan, A. & Reddihough, D. S. (2006). Post-neonatally acquired cerebral palsy in Victoria, Australia, 1970-1999. Journal of Paediatrics and Child Health, 42(10), 606-11.]
[ Abstract ]
PURPOSE: The aim of this research was to estimate the prevalence of postnatal cerebral infection leading to hemiplegic cerebral palsy (CP) in Stockholm County and to describe the motor impairments, associated impairments and involvement of the non hemiplegic side. METHOD: Children with hemiplegic CP subsequent to a cerebral infection in the perinatal period up to the age of seven years were identified. The assessments of child psychologists and speech therapists and EEG-studies, CT-scan or MRI of the brain were extracted from the children's files. Thirteen children, with a mean age of 9.5 years, participated. The prevalence was 0.03/1000. RESULTS: Nine children suffered from mental retardation, seven took antiepileptic drugs and six had bilateral radiological anomalies. The non-hemiplegic side was involved in six of the children. CONCLUSION: Cerebral infection at an early age can cause hemiplegic CP with a high frequency of associated impairments and with involvement of the non-hemiplegic side. The infectious origin probably gives rise to a more widespread brain injury.
[Tillberg, E., Radell, U & Amark, P. (2008). Postnatal cerebral infection leading to hemiplegic cerebral palsy: Clinical description of 13 children in Stockholm, Sweden. Disability and Rehabilitation, 30(5), 338-47.]
[ Abstract ]
Shaken baby syndrome is a serious form of physical child abuse, which is frequently overlooked. It should be suspected in all children younger than one year of age, who present with drowsiness, coma, seizures or apnoea. A combination of subdural haematomas and retinal haemorrhages with minimal or no trauma and no coagulopathy is almost pathognomonic of the syndrome. The findings are caused by shaking with or without impact. Physical signs of violence are often absent and the syndrome may easily be mistaken for serious infection or seizure disorder. Many cases are fatal or lead to severe disability including blindness, cerebral palsy, mental retardation or epilepsy in about 60% of the children. There are many unresolved problems regarding diagnosis, pathophysiology, treatment, prognosis, prophylaxis and legal actions. We discuss these problems and in addition present eleven children with shaken baby syndrome.
[Lund, A. M., Sandgren, G. & Knudsen, F. U. (1998). Shaken baby syndrome [Danish]. Ugeskrist for Laeger, 160(46), 6632-7.]
[ Abstract ]
Purpose. To describe the motor function and disability of children with postnatal cerebral infection leading to hemiplegia, and to determine the severity of their motor disability. Method. The disablement process was used to describe these children. Participants included 13 children (7 girls and 6 boys, mean age 9.8 years). Traditional neurological assessment methods, together with the Movement Assessment Battery for Children and Paediatric Evaluation of Disability Inventory, were used. The children's non-hemiplegic sides were also tested. To determine severity of motor disability, new definitions were created that reflected the child's balance and fine-motor ability in relation to expected performance at his or her age. Results. The children had involvement of the non-hemiplegic leg and arm in all but one case. Balance and hand function was impaired in all. Hypotonicity was present in 10 children, weakness of hip muscles in 9. There was great variation in grip function. Motor difficulties dominated during pre-school years, whereas the dominant problem of all school-age children was social and communication skills. Behavioural, communicative, and chewing and swallowing problems were common. Conclusions. A postnatal infectious aetiology influences function on both the hemiplegic and non-hemiplegic side. In school-age children, social skills and communication difficulties are more pronounced than motor problems. The results of this study encourage the use of methods standardized for age where force dynamics and quality of movement are assessed.
[Radell, U., Tillberg, E., Mattsson, E. & Amark, P. (2008). Postnatal cerebral infection leading to hemiplegic cerebral palsy: Functional limitations and disability of 13 children in Sweden. Disability and Rehabilitation, 30(25), 1910-9.]
[ Abstract ]
Primary prevention of developmental disabilities requires knowledge of the specific causes of these conditions. Postnatal causes account for 3%-15% of all developmental disabilities and often are preventable. To assess the prevalence and determine the specific etiology of postnatally acquired developmental disabilities, CDC analyzed data from its ongoing Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) for 1991 (the most recent year for which complete data were available). This report summarizes the findings of the analysis, which indicate that bacterial meningitis and child battering were the leading postnatal causes of developmental disabilities and that children with postnatally acquired developmental disabilities had a higher average number of disabilities than all other children with developmental disabilities.
[Centers for Disease Control and Prevention (CDC). (1996). Postnatal causes of development disabilities in children aged 3-10 years--Atlanta, Georgia, 1991. Morbidity and Mortality Weekly Report, 45(6), 130-4.]
[ Abstract ]
Neonatal herpes simplex virus infection with involvement of the central nervous system is a serious disease with high morbidity, even with acyclovir therapy. The disability includes cerebral palsy and different aspects of cognitive dysfunction which are of utmost importance for the child's future habilitation. We conducted a descriptive cohort study to define neuropsychologic outcomes and determine the relationship between neonatal neuroimaging and neuropsychologic outcomes. Among 267,690 children born in the Stockholm area over 12 years (1989-2000), 14 were diagnosed with neonatal herpes including central nervous system involvement. Nine children were neuropsychologically evaluated. Neonatal herpes virus infection had an even greater impact on cognitive function, speech ability, and attention deficit than anticipated. Relapse leading to deterioration was demonstrated in one child. Social skills were influenced to a lesser degree. Neurodevelopmental outcomes of the children were not well-correlated with extent of cerebral damage as visualized by computed tomography at 7-28 days after onset of signs. Neuropsychologic assessment is essential in the habilitation of the child, and a prerequisite for the evaluation of new treatments and for the assessment of deterioration of cerebral function related to relapses.
[Engman, M. L., Adolfsson, I., Lewensohn-Fuchs, I., Forsgren, M., Mosskin, M. & Malm, G. (2008). Neuropsychologic outcomes in children with neonatal herpes encephalitis. Pediatric Neurology, 38(6), 398-405.]
[ Abstract ]
The authors report six neonates with enteroviral meningoencephalitis. Five infants presented with prolonged seizures, and one presented with systemic enteroviral disease. Cranial ultrasonography showed increased echogenicity in the periventricular white matter, and MRI confirmed mild to severe white matter damage in all infants, which looked similar to periventricular leukomalacia. Two infants developed cerebral palsy: one was neurologically suspect at age 18 months, and three were developmentally normal.
[Verboon-Maciolek, M. A., Groenendaal, F., Cowan, F., Govaert, P., van Loon, A. M., de Vries, L. S. (2006). White matter damage in neonatal enterovirus meningoencephalitis. Neurology, 66(8), 1267-9.]
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Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines. OBJECTIVE: The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS. METHOD AND PATIENTS: We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR. RESULTS: This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case). CONCLUSION: This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.
[Jaidane, H., Chouchane, C., Gharbi, J., Chouchane, S., Merchaoui, Z., Ben Meriem, C., Anouni, M. & Guediche, M. N. (2005). Neuromeningeal enterovirus infections in Tunisia: Epidemiology, clinical presentation, and outcome of 26 pediatric cases [French]. Medecine et Maladies Infectieuses, 35(1), 33-8.]
[ Abstract ]