CEREBRAL PALSY MEDICAL BACKGROUND
1
, CEREBRAL PALSY
I. PATHOPHYSIOLOGY
The etiology of Cerebral Palsy is often not well understood. There are different factors that can
contribute to brain injury and cerebral palsy such as prematurity, infection, inflammation,
trauma, and coagulopathy. CP has a multifactorial course. These causes can occur in different
stages of development.
2
, PATHOPHYSIOLOGY OF CEREBRAL PALSY SPASTIC:
Preterm infants
The premature neonatal brain is susceptible to two main pathologies: intraventricular hemorrhage
(IVH) and periventricular leukomalacia (PVL). Although both pathologies increase the risk of CP,
PVL is more closely related to CP and is the leading cause in preterm infants. The term PVL
describes white matter in the periventricular region that is underdeveloped or damaged
(“leukomalacia”). Both IVH and PVL cause CP because the corticospinal tracts, composed of
descending motor axons, course through the periventricular region.
Intraventricular hemorrhage (IVH)
IVH describes bleeding from the subependymal matrix (the origin of fetal brain cells) into the ventricles
of the brain. The blood vessels around the ventricles develop late in the third trimester, thus preterm
infants have underdeveloped periventricular blood vessels, predisposing them to increased risk of
IVH. The risk of CP increases with the severity of IVH.
Periventricular leukomalacia (PVL)
IVH is a risk factor for PVL, but PVL is a separate pathological process. The pathogenesis of PVL arises
from two important factors: (1)ischemia/hypoxia and (2) infection/inflammation.
Intraventricular Hemorrhage Grading:
Grade I hemorrhage: bleeding is isolated to the subependymal area
Grade II hemorrhage: bleeding within the ventricle but without evidence of ventricular dilation
Grade III hemorrhage: consists of IVH with ventricular dilation
Grade IV hemorrhage: there is intraventricular and parenchymal haemorrhage
3
1
, CEREBRAL PALSY
I. PATHOPHYSIOLOGY
The etiology of Cerebral Palsy is often not well understood. There are different factors that can
contribute to brain injury and cerebral palsy such as prematurity, infection, inflammation,
trauma, and coagulopathy. CP has a multifactorial course. These causes can occur in different
stages of development.
2
, PATHOPHYSIOLOGY OF CEREBRAL PALSY SPASTIC:
Preterm infants
The premature neonatal brain is susceptible to two main pathologies: intraventricular hemorrhage
(IVH) and periventricular leukomalacia (PVL). Although both pathologies increase the risk of CP,
PVL is more closely related to CP and is the leading cause in preterm infants. The term PVL
describes white matter in the periventricular region that is underdeveloped or damaged
(“leukomalacia”). Both IVH and PVL cause CP because the corticospinal tracts, composed of
descending motor axons, course through the periventricular region.
Intraventricular hemorrhage (IVH)
IVH describes bleeding from the subependymal matrix (the origin of fetal brain cells) into the ventricles
of the brain. The blood vessels around the ventricles develop late in the third trimester, thus preterm
infants have underdeveloped periventricular blood vessels, predisposing them to increased risk of
IVH. The risk of CP increases with the severity of IVH.
Periventricular leukomalacia (PVL)
IVH is a risk factor for PVL, but PVL is a separate pathological process. The pathogenesis of PVL arises
from two important factors: (1)ischemia/hypoxia and (2) infection/inflammation.
Intraventricular Hemorrhage Grading:
Grade I hemorrhage: bleeding is isolated to the subependymal area
Grade II hemorrhage: bleeding within the ventricle but without evidence of ventricular dilation
Grade III hemorrhage: consists of IVH with ventricular dilation
Grade IV hemorrhage: there is intraventricular and parenchymal haemorrhage
3
