Most severe form of spastic cerebral palsy is spastic quadriplegia, in which all four limbs and the trunk are affected. A spastic quadriplegic also has difficulties in controlling the muscles of the mouth and tongue. Children with spastic quadriplegia often are also diagnosed with mental retardation. Complications of spastic quadriplegia include dysfunction of the muscles of the mouth and tongue, seizures, increased risk for cognitive difficulties, bowel and bladder dysfunction, scoliosis, hip dislocation, tooth decay and skin sores.
Over 40% of cerebral palsy patients have a form of spastic quadriplegia. In many cases, spastic quadriplegia is the result of infections, coagulation disorders, trauma or complications during pregnancy or birth. Spastic quadriplegia occurs when there is deprivation of oxygen (asphyxia) to the brain during labor and/or delivery. When this birth asphyxia is severe or occurs for a lengthy period of time, it can result in brain damage called hypoxic-ischemic encephalopathy, which causes infant death or paralysis.
This oxygen deprivation can result in the most severe form of spastic cerebral palsy. It damages the part of the brain that controls voluntary movements, the motor cortex. When the motor cortex is damaged, it is hard for the brain to communicate with the muscles on either side of the body. This damage to the motor cortex on the left side of the brain also makes it difficult for a spastic quadriplegic child to control movements on the right side of their body and damage to the motor cortex on the right side makes it difficult to control movements on the left side of the body.
According to the essential criteria developed by the American College of Obstetricians and Gynecologists, in order to attribute CP to intrapartum hypoxia, the child born at 34 or more weeks of gestation must have had the clinical signs of severe or moderate neonatal encephalopathy, defined as seizures, abnormal tone, poor feeding, and a depressed level of consciousness within the first 24 hours of life.
Computed tomography (CT) scan and electroencephalogram (EEG) if obtained during the first 24 hours will be abnormal. In addition, evidence of a metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH< 7and base deficit >/ = 12 mmol/L) is needed, as well as exclusion of other identifiable etiologies such as trauma, coagulation disorders, infectious conditions, or genetic disorders.
While the cause of cerebral palsy may vary, the most common form of CP attributable to acute hypoxic intrapartum events is spastic quadriplegic. Spastic quadriplegia, however, may result from causes other than intrapartum hypoxia. Other complications spastic quadriplegia usually will include epilepsy. Extensive bilateral cerebral and basal ganglia lesions, associated with spastic quadriplegia and the most adverse outcome, commonly signal epilepsy and severe cognitive, motor, visual and auditory impairments.
Spastic Quadriplegia Lawsuit
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