From the Guidelines
Hemiplegic cerebral palsy is primarily associated with risk factors such as prematurity, low birth weight, and birth complications, as well as genetic factors and maternal infections during pregnancy, as indicated by the most recent study 1. The primary risk factors for hemiplegic cerebral palsy include:
- Perinatal stroke, which is the most common cause of hemiplegic cerebral palsy
- Periventricular hemorrhage, periventricular leukomalacia, and intrauterine infections
- Maternal factors such as preeclampsia, placental abnormalities, and maternal infections during pregnancy
- Premature birth, particularly before 32 weeks gestation, and low birth weight (less than 2500g)
- Birth complications including prolonged labor, birth asphyxia, and umbilical cord problems that lead to oxygen deprivation
- Genetic factors, with certain genetic mutations or abnormalities predisposing children to hemiplegic cerebral palsy, as supported by a study on the diagnostic yield of exome sequencing in cerebral palsy 1
- Multiple gestations (twins, triplets) carry higher risk due to increased complications and competition for nutrients Understanding these risk factors is crucial for early identification of at-risk infants, allowing for prompt intervention and potentially improved outcomes through early therapeutic approaches, as recommended by studies on early detection and diagnosis of cerebral palsy 1. Key points to consider in the diagnosis and management of hemiplegic cerebral palsy include:
- Early standardized assessments and investigations for early detection of cerebral palsy
- Use of a combination of standardized motor assessment and neuroimaging to detect abnormal neuroanatomy in the motor areas of the brain
- Identification of infants with newborn-detectable risks, such as preterm birth, neonatal encephalopathy, and birth defects, for early intervention and surveillance
- Provision of psychological and financial support to parents of at-risk infants, as recommended by studies on early intervention and treatment of cerebral palsy 1.
From the Research
Risk Factors for Hemiplegic Cerebral Palsy
- Prematurity and low birthweight are important risk factors for cerebral palsy, including hemiplegic cerebral palsy 2
- Maternal infections and multiple gestation have also been associated with an increased risk for cerebral palsy 2
- Prenatal factors, such as circulatory brain lesions and maldevelopments, are considered to be the aetiology in 42% of term children with congenital hemiplegia 3
- Perinatal factors, such as cerebral haemorrhage and hypoxia, are considered to be the aetiology in 16% of term children with congenital hemiplegia 3
- Postnatally acquired hemiplegia, mainly postinfectious, iatrogenic or posttraumatic, constituted 11% of cases 3
Associated Medical Conditions
- Hemiplegic cerebral palsy is often associated with other medical conditions, such as mental retardation, epilepsy, impaired vision, hearing and speech, and severe behavioural/perceptual problems 3
- The presence of a seizure disorder in children with hemiplegic cerebral palsy can have deleterious consequences on the development of intelligence and memory 4
- Early lateralized lesions that are accompanied by a seizure disorder can result in a high incidence and degree of deficit, regardless of the side of the lesion 4
Diagnostic Factors
- The diagnosis of cerebral palsy, including hemiplegic cerebral palsy, is primarily based on clinical findings 2
- Magnetic resonance imaging (MRI) can be used to delineate the extent of brain lesions and to identify congenital brain malformations 2
- Computerised tomography (CT) can be used to correlate with clinical degree of severity and magnitude of associated handicap 3