HYPOXIC-ISCHEMIC BRAIN
INJURY of the NEWBORN
& CEREBRAL PALSY
Jin S. Hahn, M.D.
Cerebral Palsy: Definition
Group of disorders that
• present after birth
• characterized by abnormal control of
movement or posture
• absence of recognized underlying progressive
disease
Not a single disease, but group of conditions
• different parts of body involved
• other associated disabilities.
Cerebral Palsy: History
William John Little
1861
Sigmund Freud
1889
William John Little
Orthopedic surgeon who observed that
children with tone and developmental
abnormalities often had prolonged labor,
prematurity or breech delivery.
“Motor deformities resulted from difficulties
in the birth process.”
1861
Sigmund Freud
“Cerebral palsy is not caused by a
difficult birthing process or
perinatal difficulties.”
“CP is the result of some injury to
the brain that occurred during
pregnancy which leads to CP and
predisposes the infants to difficult
deliveries.”
Cerebral Palsy: Epidemiology
• 1.2 to 2.3 children per 1000 by early
school age
• 10-15% of CP is acquired through
known brain injury, infection or
trauma after first month of life
CP: Clinical Phenotypes
• Spastic Quadriplegia
• Spastic Diplegia
• Spastic Hemiplegia
• Extrapyramidal CP
• Mixed CP
• Others
Hypotonic CP
Ataxic CP
Spastic Quadriplegia
• aka double hemiparesis
• involves all four limbs, arms at least
severely affected as legs
• bilateral hemisphere involvement, severely
impaired and MR
• often have bulbar symptomatology
• 9–43% of all CP
CP: Spastic Quadriplegia
“Scissoring”
of lower limbs
“Fisting”
Spastic Diplegia
• involves legs more than arms
• often associated with premature births
• only 11-20% are severely impaired
• MR not so profound
• 10–33% of all CP
CP: Spastic Diplegia
Contractures
of hips, knees,
and feet (talipes
equinovarus)
Spastic Hemiplegia
• involvement of arm and leg on one side
(arm>leg)
• motor handicaps least likely to be disabling
• intelligence is normal to dull
• 25–40% of all CP
CP: Spastic Hemiplegia
Hemiplegia on the