How Cerebral Palsy Is Diagnosed

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cerebral palsy diagnosis
© Verywell, 2018

Cerebral palsy is a condition that is present at birth or shortly after birth. One of the key features in the diagnosis is that children do not reach developmental milestones, whereas, with some other neurological conditions, children reach milestones and then decline over time.

The diagnosis of cerebral palsy requires a careful and methodical process that relies largely on observation and clinical examination.

If you suspect a diagnosis, an understanding of the process can help alleviate concerns.

Self Checks 

Children who have cerebral palsy may display a variety of symptoms that are central to the diagnosis of the condition. Symptoms include motor weakness of the face, arms, hands, legs or trunk, stiff and jerky movements or floppy muscles, speech that is spastic and difficult to understand, problems chewing and swallowing, and cognitive deficits.

As a parent or caregiver, noticing these symptoms may be stressful and concerning. To make sure they are addressed appropriately, it may be helpful to jot down specifics about them—timing, activities before/after, and more can be helpful to a doctor during your communication.

Labs and Tests

There are several tests that support and confirm the diagnosis of cerebral palsy, the most important of which is a clinical history and physical examination.

Clinical History and Physical Examination. 

A clinical history can identify events such as traumatic injuries, childhood infections and illnesses such as digestive, breathing and heart problems that can cause symptoms that appear similar to those of cerebral palsy, particularly in very young babies.

An evaluation of a child’s abilities using a detailed neurological exam is between 90-98 percent accurate in diagnosing cerebral palsy.

A few other methods of testing a child’s abilities include the Prechtl Qualitative Assessment of General Movements and the Hammersmith Infant Neurological Examination, both of which systematically assess and score a child’s physical and cognitive abilities on a scale.

Blood Tests 

Blood tests are not expected to show abnormalities in cerebral palsy. Metabolic syndromes that are characterized by symptoms similar to those of cerebral palsy are expected to show blood test abnormalities, which can help in differentiating the conditions. A blood test may also be considered if a child with symptoms of cerebral palsy has symptoms of an illness, organ failure or an infection.

Genetic Tests 

Genetic tests may help in identifying genetic abnormalities associated with cerebral palsy. Cerebral palsy is only rarely associated with verifiable genetic defects, and the greater value of genetic testing lies in the diagnosis of other conditions that are clinically similar to cerebral palsy and that have known genetic patterns.

Not everyone is open to having a genetic test. If you have concerns, talk to your doctor. Also, discuss with your partner—planning for what to do when results are ready may help both of you cope and support each other better.

Electroencephalogram EEG

Some children with cerebral palsy have seizures. Some types of epilepsy that are not associated with cerebral palsy can have a profound impact on childhood development. In these types of seizure disorders, cognition may be impaired in a manner that is clinically similar to the cognitive deficits seen in cerebral palsy, and an EEG can help identify subclinical (not obvious) seizures. 

Nerve Conduction Studies (NCV) and Electromyography (EMG)

Some muscle and spine diseases may cause weakness that begins at a very early age. Nerve and muscle abnormalities are not characteristic of cerebral palsy, and therefore abnormal patterns on these tests can help rule in other conditions and rule out cerebral palsy.

Imaging

Brain imaging generally does not confirm cerebral palsy itself, but it can identify one of the other conditions that may produce symptoms similar to those of cerebral palsy.

Brain CT

The brain CT scan of a child with cerebral palsy may be normal or may show evidence of a stroke, or anatomical abnormalities. Patterns suggesting that a child’s symptoms are not cerebral palsy include an infection, fractures, bleeding, a tumor or hydrocephalus.

Brain MRI

A brain MRI is a more detailed imaging study of the brain than a CT scan. The presence of some types of malformations, as well as abnormalities suggestive of prior ischemic injuries (lack of blood flow) to the white or gray matter of the brain, may support the diagnosis of cerebral palsy. Evidence of active inflammation may point to other conditions such as cerebral adrenoleukodystrophy.

In both of these imaging tests, a child (and caregiver) may feel fearful. Ask if there's anything that can be done to help ease the experience for the child—activities, having someone nearby, or using specific kid-friendly language may be something the doctor can offer.

Differential Diagnosis

The treatment, management, and prognosis of cerebral palsy differ from that of other similar conditions, and this is one of the reasons that accurate diagnosis is so important. Some of these conditions are associated with a clear hereditary risk, and therefore identification of the condition in one child can help parents with early recognition and treatment of their other children, in addition to providing information to the whole family that can be useful in reproductive planning.

Shaken Baby Syndrome 

A condition caused by repeated trauma—shaken baby syndrome—can affect young children of all ages, and is more common in older babies than in newborns. Shaken baby syndrome is characterized by skull fractures, hemorrhage (bleeding) in the brain, and often trauma to other areas of the body.

Depending on when the trauma begins, shaken baby syndrome can result in a loss of cognitive skills that have already begun to emerge, while cerebral palsy is characterized by lack of emerging skills.

Rett Syndrome 

A rare condition that affects girls, Rett syndrome may cause lack of motor control and cognitive deficits. The biggest differences between the conditions are that children with Rett syndrome develop normally for 6 to 12 months, and then show a decline in function, while children with cerebral palsy do not attain developmental milestones.

Autism Spectrum Disorder 

A complicated disorder with symptoms that can manifest as cognitive and behavioral deficits, some children on the autism spectrum can display motor or speech deficits with characteristics that may be mistaken for cerebral palsy or the other way around. 

Metabolic Syndromes

Conditions that interfere with metabolism or with protein production such as Tay Sacks disease, Noonan Syndrome, Lesch-Nyan syndrome, and Neimann-Pick disease can all have features of motor weakness and cognitive deficits that may be mistaken for cerebral palsy—and cerebral palsy can be mistaken for these conditions.

In addition to some trademark physical features, metabolic syndromes often show abnormalities on specialized blood tests, which can help in differentiating them from each other and from cerebral palsy.

Encephalitis 

Encephalitis, which is inflammation of the brain, can cause profound symptoms ranging from seizures to paralysis to unresponsiveness. There are two main categories of encephalitis, which are infectious and inflammatory. 

  • Infectious: Infectious encephalitis is characterized by rapid onset, and as evidence of infection and inflammation on blood tests, brain CT, brain MRI or in lumbar fluid. 
  • Inflammatory: Inflammatory encephalitis may be serious despite the lack of an infectious cause. There may be associated fevers and usually blood tests, brain CT, brain MRI and lumbar fluid show evidence of inflammation. 

Spinal Muscular Atrophy 

A disorder that can begin during infancy, childhood, or adulthood, the form of spinal muscular atrophy that begins during infancy can be devastating, causing paralysis or near paralysis. The motor weakness of early onset spinal muscular atrophy, also often referred to as SMA type 0, is more debilitating than that of cerebral palsy. The illness is expected to rapidly progress to a fatal outcome, which is not typical with cerebral palsy. 

Cerebral Adrenoleukodystrophy

A rare disorder characterized by visual deficits and cognitive decline, cerebral adrenoleukodystrophy predominantly affects boys. The key differences between adrenoleukodystrophy and cerebral palsy are that children with cerebral adrenoleukodystrophy have white matter abnormalities on their brain MRI and the condition causes a decline in cognitive and motor function, not a lack of development of skills as in cerebral palsy. 

Muscular Dystrophy 

There are several types of muscular dystrophy, all characterized by weakness and lack of muscle tone. The differences between cerebral palsy and muscular dystrophy are that muscular dystrophy is usually not associated with cognitive deficits, and the muscle weakness of muscular dystrophy can be distinguished as being caused by muscle disease through a physical examination and by EMG/ NCV studies.

Source:

Novak I, Morgan C, Adde L, et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr. 2017;171(9):897-907.