Patient Overview Case Study for MBBS Students

Introduction

Mosa, a 2-year-old child, presents to Dr. Mehwish at the pediatric OPD with delays in motor milestones and an inability to stand and walk independently. This case study examines the causes, symptoms, diagnosis, and management of cerebral palsy, providing insights for medical students.

Medical History

Antenatal History:

• Normal.

Natal History:

• Labor pain not experienced even after 40 weeks of gestation.
• Labor induced by oxytocin injection.
• Full-term normal vaginal delivery not possible; lower segment cesarean section performed due to maternal exhaustion and inability to push.
• Obstructed delivery resulted in meconium-stained liquor.
• Birth asphyxia; child did not cry immediately after birth.
• NICU stay: Ventilator care for 2 days, 10 days total in NICU.

Clinical Examination

• Difficulty with coordination.
• Abnormal muscle tone (hypertonia).
• Struggles with fine and gross motor skills.
• Hypotonia in both arms and legs.
• Unsteady gait with a noticeable scissoring pattern.
• Exaggerated reflexes.
• Poor control of facial muscles.
• Developmental delays in speech.
• Family history: Parents are first cousins, similar manifestations in a deceased sibling.

Investigations

• Blood tests.
• Electroencephalogram (EEG).
• Genetic testing.
• CT scan of the brain.

Differential Diagnosis

• Cerebral palsy.
• Muscular dystrophy.
• Spinal muscular atrophy.
• Developmental coordination disorder.

Most Likely Diagnosis

Cerebral palsy due to birth asphyxia, delayed motor milestones, and hypertonia.

Signs and Symptoms of Cerebral Palsy

• Delayed motor milestones.
• Hypertonia.
• Unsteady gait.
• Difficulty with coordination.
• Speech development delay.
• Exaggerated reflexes.

Difference Between Hypertonia and Hypotonia

• Hypertonia: Increased muscle tone, stiffness, and difficulty moving limbs.
• Hypotonia: Decreased muscle tone, floppiness, and poor muscle strength.

Differentiation Between Cerebral Palsy and Muscular Dystrophy

• Cerebral Palsy: Neurological disorder caused by brain injury or malformation; affects motor skills, coordination, and muscle tone.
• Muscular Dystrophy: Genetic disorder causing progressive muscle degeneration and weakness; affects voluntary muscles.

Histological Differences Between Normal and Affected Brain Tissue in Cerebral Palsy

• Normal Brain Tissue: Well-organized neuronal structure, normal white and gray matter distribution.
• Affected Brain Tissue: Areas of brain damage, loss of neuronal organization, and possible cystic changes.

Normal Flora of the Human Gut in Infants

• Bacteria: Bifidobacterium, Lactobacillus, Enterococcus.
• Fungi: Candida (rarely in healthy infants).

Diet and Lifestyle Suggestions for Children with Cerebral Palsy

• Balanced diet rich in nutrients to support growth and development.
• Physical therapy and regular exercise to improve muscle strength and coordination.
• Speech therapy to address speech delays.
• Occupational therapy to enhance fine motor skills.
• Use of assistive devices as needed for mobility and daily activities.

Management and Treatment

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Regular follow-up with a pediatric neurologist.
• Genetic counseling for parents.
• Medications to manage spasticity and other symptoms.
• Use of orthotic devices to support mobility.

Potential Complications

• Contractures.
• Joint dislocations.
• Respiratory issues.
• Feeding difficulties.
• Developmental delays.

Note for MBBS Students

A multidisciplinary approach involving pediatricians, neurologists, geneticists, and therapists is crucial for optimal management and care.

Conclusion

This case highlights the importance of timely diagnosis and intervention in cerebral palsy. A comprehensive management plan involving medical and rehabilitative strategies is essential to improve the child’s quality of life and developmental outcomes. Always consult a healthcare professional for personalized medical advice.

For more detailed information on cerebral palsy and related topics, visit MSMBBs Blog.