eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

Cerebral Palsy: Differential Diagnoses & Workup

Author: Christine Thorogood, MD, Associate Professor of Pediatric Physical Medicine and Rehabilitation, Eastern Virginia Medical School
Coauthor(s): Michael A Alexander, MD, FAAPMR, FAAP, Professor, Chief of Division of Rehabilitation Medicine, Departments of Pediatrics and Rehabilitation Medicine, Thomas Jefferson Medical College; Chief of Rehabilitation Medicine, Alfred I duPont Hospital for Children
Contributor Information and Disclosures

Updated: Mar 11, 2009

Differential Diagnoses

Acid Maltase Deficiency Myopathy
Neonatal Brachial Plexus Palsies
Acute Poliomyelitis
Postpolio Syndrome
Becker Muscular Dystrophy
Posttraumatic Syringomyelia
Charcot-Marie-Tooth Disease
Spasticity
Kugelberg Welander Spinal Muscular Atrophy
Stroke Motor Impairment
Lacunar Stroke
Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology
Limb-Girdle Muscular Dystrophy
Multiple Sclerosis
Myelomeningocele

Other Problems to Be Considered

Metabolic and genetic diseases

Workup

Laboratory Studies

  • There are no definitive lab studies for diagnosing cerebral palsy, only studies to rule out other symptom causes, such as metabolic or genetic abnormalities, as deemed necessary based on clinical examination.
    • Thyroid studies
    • Lactate level
    • Pyruvate level
    • Organic and amino acids
    • Chromosomes
    • Cerebrospinal protein - Levels may assist in determining asphyxia in the neonatal period. Protein levels can be elevated, as can the lactate-to-pyruvate ratio.

Imaging Studies

  • Neuroimaging studies can help to evaluate brain damage and to identify persons who are at risk for cerebral palsy. Data to support a definitive diagnosis of cerebral palsy are lacking.
    • Neonatal ultrasonography provides information about the ventricular system, basal ganglia, and corpus callosum, as well as diagnostic information on intraventricular hemorrhage and hypoxic-ischemic injury to the periventricular white matter. Periventricular leukomalacia initially appears as an echodense area that converts to an echolucent area when the patient is approximately age 2 weeks. Periventricular leukomalacia is strongly associated with cerebral palsy. (See image below and Image 2.)
    • Computed tomography (CT) scanning provides information to help in diagnosing congenital malformations, intracranial hemorrhages, and periventricular leukomalacia, especially in the infant.
    • Magnetic resonance imaging (MRI) is most useful after 2-3 weeks of life. MRI is the best study for assessing white matter disease in an older child.
    • Evoked potentials are used to evaluate the anatomic pathways of the auditory and visual systems.
    • A normal brain imaging study does not mean that the child does not have cerebral palsy, since the diagnosis is always based only on physical exam findings.

Magnetic resonance imaging (MRI) scan of a 1-year...

Magnetic resonance imaging (MRI) scan of a 1-year-old boy who was born at gestational week 27. Clinical examination is consistent with spastic diplegic cerebral palsy. Pseudocolpocephaly and decreased volume of the white matter posteriorly are consistent with periventricular leukomalacia. Evidence of diffuse polymicrogyria and thinning of the corpus callosum is noted.

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Magnetic resonance imaging (MRI) scan of a 1-year...

Magnetic resonance imaging (MRI) scan of a 1-year-old boy who was born at gestational week 27. Clinical examination is consistent with spastic diplegic cerebral palsy. Pseudocolpocephaly and decreased volume of the white matter posteriorly are consistent with periventricular leukomalacia. Evidence of diffuse polymicrogyria and thinning of the corpus callosum is noted.


Related eMedicine topics:
Periventricular Leukomalacia [Pediatrics: Cardiac Disease and Critical Care Medicine]
Periventricular Leukomalacia [Radiology]

Other Tests

  • Hearing and vision screens may be helpful.
  • Electroencephalography is useful in evaluating severe hypoxic-ischemic injury. Findings initially show marked suppression of amplitude and slowing, followed by a discontinuous pattern of voltage suppression, with bursts of high-voltage sharp and slow waves at 24-48 hours.

More on Cerebral Palsy

Overview: Cerebral Palsy
Differential Diagnoses & Workup: Cerebral Palsy
Treatment & Medication: Cerebral Palsy
Follow-up: Cerebral Palsy
Multimedia: Cerebral Palsy
References
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References

  1. Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. Aug 2005;47(8):571-6. [Medline].

  2. Badawi N, Watson L, Petterson B, et al. What constitutes cerebral palsy?. Dev Med Child Neurol. Aug 1998;40(8):520-7. [Medline].

  3. Dabney KW, Lipton GE, Miller F. Cerebral palsy. Curr Opin Pediatr. Feb 1997;9(1):81-8. [Medline].

  4. Jones MW, Morgan E, Shelton JE, et al. Cerebral palsy: introduction and diagnosis (part I). J Pediatr Health Care. May-Jun 2007;21(3):146-52. [Medline].

  5. Girard S, Kadhim H, Roy M, et al. Role of perinatal inflammation in cerebral palsy. Pediatr Neurol. Mar 2009;40(3):168-74. [Medline].

  6. Mayston MJ. People with cerebral palsy: effects of and perspectives for therapy. Neural Plast. 2001;8(1-2):51-69. [Medline].

  7. Mattern-Baxter K. Effects of partial body weight supported treadmill training on children with cerebral palsy. Pediatr Phys Ther. Spring 2009;21(1):12-22. [Medline].

  8. Verrall TC, Berenbaum S, Chad KE, et al. Children with cerebral palsy: caregivers' nutrition knowledge, attitudes and beliefs. Can J Diet Pract Res. 2000;61(3):128-34. [Medline].

  9. Scholtes VA, Dallmeijer AJ, Knol DL, et al. The combined effect of lower-limb multilevel botulinum toxin type a and comprehensive rehabilitation on mobility in children with cerebral palsy: a randomized clinical trial. Arch Phys Med Rehabil. Dec 2006;87(12):1551-8. [Medline].

  10. Dai AI, Wasay M, Awan S. Botulinum toxin type A with oral baclofen versus oral tizanidine: a nonrandomized pilot comparison in patients with cerebral palsy and spastic equinus foot deformity. J Child Neurol. Dec 2008;23(12):1464-6. [Medline].

  11. Yang EJ, Rha DW, Kim HW, Park ES. Comparison of botulinum toxin type A injection and soft-tissue surgery to treat hip subluxation in children with cerebral palsy. Arch Phys Med Rehabil. Nov 2008;89(11):2108-13. [Medline].

  12. Pascual-Pascual SI, Pascual-Castroviejo I. Safety of botulinum toxin type A in children younger than 2 years. Eur J Paediatr Neurol. Nov 24 2008;[Medline].

  13. Abstracts of the 5th International Congress on Cerebral Palsy. Bled, Slovenia, 7-10 June 2001. Brain Dev. Jun 2001;23(3):145-93. [Medline].

  14. Kuban KC, Leviton A. Cerebral palsy. N Engl J Med. Jan 20 1994;330(3):188-95. [Medline].

  15. Matthews DJ, Wilson P. Cerebral palsy. In: Molnar GE, Alexander MA, eds. Pediatric Rehabilitation. 3rd ed. Philadelphia, Pa: Hanley & Belfus; 1999:192-217.

  16. Taketomo CT, Hodding JH, Kraus DM. Pediatric Dosage Handbook. 4th ed. Cleveland, Ohio: Lexi-Comp; 1997.

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Further Reading

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Keywords

cerebral palsy, palsy, spastic, spasticity, hemiplegia, quadriplegia, diplegia, palsy treatment, children with cerebral palsy, cerebral palsy symptoms, cerebral palsy treatment, spastic diplegia, spastic cerebral palsy, ataxic cerebral palsy, spastic quadriplegia, spastic monoplegia, cerebral palsy causes, monoplegia, encephalopathy, spastic palsy, dyskinetic palsy, ataxic palsy

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Contributor Information and Disclosures

Author

Christine Thorogood, MD, Associate Professor of Pediatric Physical Medicine and Rehabilitation, Eastern Virginia Medical School
Christine Thorogood, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Michael A Alexander, MD, FAAPMR, FAAP, Professor, Chief of Division of Rehabilitation Medicine, Departments of Pediatrics and Rehabilitation Medicine, Thomas Jefferson Medical College; Chief of Rehabilitation Medicine, Alfred I duPont Hospital for Children
Michael A Alexander, MD, FAAPMR, FAAP is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Teresa L Massagli, MD, Residency Director, Professor, Department of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine
Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kat Kolaski, MD, Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine
Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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