The Diagnosis of Cerebral Palsy

Diagnosing cerebral palsy is a difficult process as there are other health problems that can mimic the condition. A cerebral palsy diagnosis does not necessarily follow even though a child may exhibit some of the symptoms.

Symptoms, under six months

Children under the age of six months may demonstrate some or all of the following indicative symptoms:

  • Lethargy
  • Irritability
  • Abnormal crying
  • Trembling of the arms and legs
  • Feeding difficulties
  • Poor muscle tone
  • Abnormal posture
  • Seizures, staring spells, eye fluttering or body twitching
  • Abnormal reflexes
  • Changing muscle tone from floppy to very stiff
  • Hand held in tight fist
  • Asymmetry of movement

Symptoms, six months and over

Brain damaged children over the age of six months usually have obvious difficulties and are often slow to reach developmental milestones such as rolling over, sitting up, crawling, walking and talking.

Whilst parents will often notice problems, particularly if this is not their first child, medical professionals are often reluctant to diagnose cerebral palsy as a child's central nervous system may recover after an injury; they may use broader terms such as:

  • Developmental delay
  • Neuromotor dysfunction
  • Motor disability
  • Central nervous system dysfunction
  • Static encephalopathy
  • Prior to making a cerebral palsy diagnosis a consultant must rule out other disorders that cause movement problems, identify any coexisting disorders and determine if the condition is changing. There are a number of techniques available:
  • Declining motor skills may indicate genetic disease, muscle or metabolic disorder, or tumour in the nervous system.
  • An electroencephalogram (EEG) traces electrical activity in the brain and can reveal patterns that suggest a seizure disorder.
  • Electromyography and nerve conduction studies can identify a nerve or muscle disorder.
  • Chromosome analysis may be performed to identify a genetic anomaly.
  • Thyroid function tests may reveal low levels of thyroid hormone, which can produce several congenital defects and severe mental retardation.
  • A high level of ammonia in the blood is toxic to the central nervous system. This may be due to a liver disorder or a defect in metabolism.
  • Imaging tests may diagnose hydrocephalus, structural abnormalities, and tumours.
  • Magnetic resonance imaging (MRI) defines abnormalities of white matter and motor cortex.
  • A head CT scan can show congenital malformations, haemorrhage, and periventricular leukomalacia in infants.
  • Ultrasound can detect cysts and abnormal structures in the brain.

Diagnosis techniques

A cerebral palsy diagnosis can not be made quickly or easily as the extent of the child's problems may not become clear for some time. Doctors need to test the child's motor skills and look carefully at the medical history, paying special attention to any instances of slow development, abnormal muscle tone or unusual posture.

Intelligence testing is also used to help determine if a child has any intellectual impairment, however intelligence testing a child with movement difficulties does not always give an accurate result. A doctor must move carefully towards a diagnosis after eliminating all other possible causes.

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