A cerebral palsy diagnosis is made by a variety of medical specialists using multiple tests, which can include neurological imaging, screenings for disabilities, disorders, and coagulation issues, and reflex tests, among others. Sometimes a cerebral palsy diagnosis may be difficult to make since there isn’t one single comprehensive test that can confirm it or rule it out. In severe cases, early signs of brain injury are apparent and a diagnosis can be made. However, in mild to moderate cases, a diagnosis sometimes cannot be made until the child’s brain is more developed (around 3-5 years old). The timeline for when children are diagnosed with cerebral palsy varies significantly depending on the severity of the condition and other factors.
All children should have a detailed history taken and a thorough physical exam performed by their physician. It is very important to determine that the condition is static – meaning the brain injury won’t get worse over time – rather than progressive or degenerative. The brain injury that causes cerebral palsy is a static one (although the initial injury will evolve). Repeated examinations over time usually are required to determine if the condition is static or progressive. Another reason that is important for the physician to take a detailed history and perform a thorough exam and proper testing is that it is important to classify which type of cerebral palsy the child has (spastic, ataxic, athetoid/dyskinetic, etc.).
Using Neuroimaging to Diagnose Cerebral Palsy
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of the brain. MRI often gives different information about structures in the brain than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan, so it may reveal problems that cannot be seen with other imaging methods. It can also sometimes be combined with magnetic resonance spectroscopy (MRS), which can help understand what is going on not just on the structural level, but also on the metabolic level.
MRI of the baby’s brain can identify a brain injury, such as a lesion in the brain, in most cases of cerebral palsy. In addition, MRI may provide information regarding the timing of the brain insult. MRI abnormalities in babies with cerebral palsy include hypoxic-ischemic lesions, such as those associated with hypoxic-ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL).
MRI takes longer than other brain imaging techniques, and metal cannot go in the machine. Thus, babies who are unstable, and/or are using machines that have metal (such as a ventilator or incubator), may not be able to have MRI performed. However, there are incubators and ventilators made with no metal that can be used during MRI. In addition, there are techniques that clinicians can use to help the baby tolerate the test, such as the “feed and bundle” technique. Indeed, MRI gives such important information about the brain that clinicians should make every effort to have this test performed on the baby, in most cases.
A computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside the brain. Typically, exposure to radiation should be avoided or minimized in babies. While CT scans can identify brain abnormalities in many babies and children with cerebral palsy, MRI is preferred because it has a better capacity for detecting brain injury. Furthermore, research shows that MRI is much better at helping to detect the timing of the insult that caused the cerebral palsy, and it is better at helping to determine the actual cause of the cerebral palsy.
Screening for Problems Associated with Cerebral Palsy
Screening for developmental disability, vision and hearing problems, speech and language disorders, and disorders of mouth muscle function must be performed as part of the initial assessment for cerebral palsy because these problems are commonly associated with cerebral palsy.
Using EEG Testing to Diagnose Cerebral Palsy
An electroencephalogram (EEG) must be performed when there are features that suggest the child has epilepsy. The reason for this is that seizures occur in about 45% of children who have cerebral palsy. Epilepsy and seizure disorders must be promptly diagnosed and treated because seizures can worsen brain damage, which can increase the severity of cerebral palsy. Furthermore, seizure activity can cause new brain injuries – injuries that cause problems in addition to the cerebral palsy.
Screening for Coagulation Problems to Diagnose Cerebral Palsy
Some children with hemiplegic cerebral palsy or MRI findings that show cerebral infarction (brain tissue death caused by oxygen deprivation [HIE]) may have a blood clotting disorder called prothrombotic coagulation disorder. It is standard practice to screen for coagulation abnormalities in such patients, so that this disorder can be properly managed. Children with hemiparesis, which is less severe than hemiplegia, should be tested for HIE.
Using Reflex Tests to Diagnose Cerebral Palsy
In normally-developing babies, most developmental reflexes pertaining to posture disappear when the baby is between 3 and 6 months of age. These reflexes do not disappear when a child has cerebral palsy. Therefore, delay in the disappearance of a developmental reflex may be an early indication of cerebral palsy. Exaggerated developmental reflexes are also an early sign of cerebral palsy.
Testing the tonic labyrinthine reflex (TLR) is very important. The TLR is a primitive reflex found in newborns. With this reflex, tilting the head back while lying on the back (supine position) causes the back to stiffen and arch backwards, the legs to straighten, stiffen and push together, the toes to point, the arms to bend at the elbows and wrists, and the hands to become fisted or the fingers to curl. The presence of the TLR past the first 6 months of life may indicate that the child has cerebral palsy. In children with cerebral palsy, the TLR may even be more pronounced.
Other abnormal signs can be elicited by the physician when the infant is held in vertical suspension. During a baby’s first few months, the appropriate response is for the baby to assume a sitting position that looks as if they are sitting in the air. An abnormal response when the baby is held in a supported upright position involves leg extension followed by or associated with an abnormal positive support reaction (a reaction where an infant supports some of their own weight, extending the legs and trunk for several seconds and stiffening the legs). Another abnormal response is when the baby keeps the legs extended for more than 30 seconds, especially when accompanied by equinus posturing (tip toe position).
A diagnosis of cerebral palsy involves assessment by medical and therapeutic specialists from a variety of fields. The most commonly consulted specialists include pediatric neurologists, developmental specialists, neuroradiologists, orthopedic surgeons, and ophthalmologists. It is crucial that cerebral palsy be diagnosed as soon as possible so that treatment and therapy can begin. Research shows that aggressive and consistent treatment and therapy are associated with better outcomes for the child.
Hypothermia Treatment, Hypoxic-Ischemic Encephalopathy (HIE), and Cerebral Palsy
Hypothermia (brain cooling) treatment should not be postponed while assessment for brain injury is taking place. Hypothermia treatment should be administered to any infant who has suffered HIE within an hour or two before birth. Time is critical when it comes to hypothermia treatment because the treatment should be initiated within six hours of the suspected brain insult. Brain cooling treatment has been shown to minimize or prevent brain damage that occurs as a result of oxygen deprivation, which can in turn minimize or prevent the symptoms of cerebral palsy.
Award-Winning Cerebral Palsy Lawyers
If you are seeking the help of a cerebral palsy lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost three decades.
Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report, which also recognized ABC Law Centers as one of the best law firms in the country. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder, or hypoxic-ischemic encephalopathy (HIE), the attorneys at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent. Our birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. Reach out today for a free case evaluation.
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Video: Michigan Cerebral Palsy Lawyers Discuss Birth Injuries and Medical Malpractice
View our video library to see Michigan cerebral palsy lawyers Jesse Reiter & Rebecca Walsh discuss causes of and treatments for cerebral palsy and other birth injuries.
- Miller, G. Diagnosis and classification of cerebral palsy. In: UpToDate, Hoppin, AG (Ed), UpToDate, Waltham, MA, 2013.
- Ashwal S, Russman BS, Blasco PA, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 62:851.
- Burns YR, O’Callaghan M, Tudehope DI. Early identification of cerebral palsy in high risk infants. Aust Paediatr J 1989; 25:215.
- Capute AJ. Identifying cerebral palsy in infancy through study of primitive-reflex profiles. Pediatr Ann 1979; 8:589.
- Foley J. Physical aspects. In: Cerebral Palsy and the Young Child, Blencowe SM (Ed), E&S Livingstone, London 1969. p.15.
- Zafeiriou DI, Tsikoulas IG, Kremenopoulos GM. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Pediatr Neurol 1995; 13:148.
- Scherzer AL, Tsharnuter I. Early Diagnosis and Therapy in Cerebral Palsy, Marcel Dekker, New York 1982.