Brain Injury and Brain Malformation

The cause of cerebral palsy is brain injury or brain malformation that occurs while the brain is developing — before, during, or after birth. Cerebral palsy affects muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.

Every case of cerebral palsy is unique to the individual. This is due in part by the type of injury and the timing of the injury to the developing brain. The brain damage that causes cerebral palsy is a result of either:

  • Prenatal disturbance of brain cell migration - Genetic and environmental factors disturb brain cell migration as cells move to their appropriate location during brain development.
  • Prenatal poor myelination (insulation) of developing nerve cell fibers – Brain function is impeded when poor myelin provides an inadequate protective covering over nerve cells that aid in transmission.
  • Perinatal brain cell death – Events in the birthing process that rupture blood vessels or starve oxygen to the brain.
  • Postnatal non-functional or inappropriate connections (synapses) between brain cells – Trauma, infections, and asphyxia that damage connections developed in the brain.

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Source: PREVENTION OF CEREBRAL PALSY: A RESEARCH STATUS REPORT, UCP Research and Educational Foundation, 1600 Street, N.W., Suite 700, Washington, D.C. 20036, June 2002.





There are Four Types of Brain Damage That Cause Cerebral Palsy

The brain damage that causes motor impairment in cerebral palsy results from one of four types of brain injury or brain malformation.

The four types are:

DAMAGE TO WHITE MATTER TISSUE IN THE BRAIN Periventricular Leukomalacia, or PVL

  • What is periventricular leukomalacia, or PVL?
  • When does PVL occur?
  • What are the risk factors and causes of PVL?
  • What are the signs of PVL?
  • How is PVL diagnosed?
  • How is PVL treated?
  • How is PVL prevented?

LACK OF OXYGEN TO THE BRAIN OR ASPHYXIA Hypoxic-Ischemic Encephalopathy, or HIE, or Intrapartum Asphyxia

  • What is hypoxic-ischemic encephalopathy, or HIE?
  • When does HIE occur?
  • What are the risk factors and causes of HIE?
  • How is HIE diagnosed?
  • How is HIE treated?
  • How is HIE prevented?

BRAIN MALFORMATION OR ABNORMAL BRAIN DEVELOPMENT Cerebral Dysgenesis

  • What is cerebral dysgenesis?
  • When does cerebral dysgenesis occur?
  • What are the risk factors and causes of cerebral dysgenesis?
  • How is cerebral dysgenesis diagnosed?
  • How is cerebral dysgenesis treated?
  • How is cerebral dysgenesis prevented?

BRAIN HEMORRHAGE Intracranial Hemorrhage, or IVH

  • What is intracranial hemorrhage, or IVH?
  • What are the four grades of IVH?
  • What are the risk factors for IVH?li>
  • What are the most common signs of IVH?li>
  • What are the five forms of IVH?

How Did This Happen to My Child?

When a parent hears their child has received a cerebral palsy diagnosis, they question How did this happen to my child? Cause is not always determined in every instance. However, the more a parent knows about the circumstances surrounding their child’s condition, the more helpful the information can be.

A radiologist, neurologist or pediatric radiologist will share the data obtained through MRIs or a CT scan. Determining the type of brain damage is the first step to an answer. Next, gather information on the cause of the brain damage.

The images may show the type of damage, but may not unravel the full explanation of cause.

After receiving medical information from the child’s primary care physician, parents may wish to pursue a medical legal review to uncover more details about the circumstances surrounding their child’s condition.

There are many benefits to knowing cause. A family may receive peace of mind, health care practitioners can better treat and prevent the condition, and family planning decisions may be impacted.

Knowing the cause may also suggest that your child could be eligible to receive lifetime benefits. However, not every child will qualify for lifetime benefits, but for those that do, lifetime benefits can be a welcome relief.

For additional benefits that may be available for your child, read about disability benefits for children. For more information, call today!

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When Does the Brain Injury
or Brain Malformation Occur?

With the advancement of neuroimaging technology, researchers have been able to study brain injury and brain malformation to understand how genetic mutations, genetic deletions, risk factors, and health status interact to create causal pathways toward abnormal brain development. The research enables scientists to identify risk factors, prevention measures, and surgical techniques for cerebral palsy.

Many organizations are working to reduce the occurrence of cerebral palsy; understanding when, how and why brain damage occurs during various stages of development is crucial to achieving that goal.

According to the United Cerebral Palsy Research and Educational Foundation, 70% of brain damage that causes cerebral palsy occurs prior to birth, mostly in the second and third pregnancy trimesters. Twenty percent occurs during the birthing period, while 10% occurs during the first two years of life while the brain is still forming. The industry has identified four key terms to help discern “when” the brain damage occurs.

Genetic Predisposition

Parents of a child newly diagnosed with cerebral palsy ask “Is cerebral palsy genetic?” or “Is cerebral palsy hereditary?”

While cerebral palsy is not a hereditary condition, researchers have discovered that hereditary factors can predispose an individual to cerebral palsy. Although a specific genetic disorder does not directly cause cerebral palsy, genetic influences can cause small effects on many genes. Genetic influences can also develop gene-to-gene interactions or form complex interactions with multiple environmental influences.

This interaction is called “complex inheritance” or “multifactorial inheritance” and may explain why cerebral palsy can “run in the family,” a condition clinically referred to as “familial recurrence.”

Some genetic contributions to obstetric risk factors include preterm birth, placental abruption, fetal growth restriction, chorioamnionitis, preeclampsia, and breech presentations. One study, published in the Journal of Child Neurology and titled “Genetic factors in athetoid cerebral palsy” identified familial recurrence of athetoid cerebral palsy typically associated with spasticity, microcephaly, intellectual impairment, and seizures as an autosomal-recessive or X-linked-recessive inheritance.

Even still, some genetic brain disorders are caused by random gene mutations. Environmental exposure to toxins, such as cigarette smoke or pesticides, can cause spontaneous gene mutation.

Some genetic defects contribute to brain malformations, which miswire nerve cell connections and lead to cerebral palsy. There are also cases of dysfunctional hereditary genes, which prevent full development of a healthy brain.

Although familial cerebral palsy only accounts for approximately 1.6% of all cerebral palsy cases, a parent who has a child diagnosed with cerebral palsy has an increased risk of having a second child develop the condition. In these cases, molecular tests can identify the susceptible gene.

Congenital Cerebral Palsy

Many ask, “Is cerebral palsy congenital?” or “Is cerebral palsy acquired?” When a child has congenital cerebral palsy, it means the child was born with the condition. Events that occurred during pregnancy or at birth can cause congenital cerebral palsy. Although the cerebral palsy may not be diagnosed immediately, the condition exists at birth and can be detected months or years later. Seventy percent of all cases are diagnosed as congenital.

A child who has a genetic predisposition to cerebral palsy can be labeled as having congenital cerebral palsy if the genetic interaction occurred while the brain was developing.

Causes of congenital cerebral palsy include lack of oxygen, complex pregnancies, medical malpractice, preterm birth, low birth weight, growth restriction, sexually transmitted disease, birth positioning, placental complications, fetal strokes, bleeding in the brain, poorly treated health conditions, trauma to the developing fetus and exposure to toxins during critical stages of development. Infections and fevers also contribute to the occurrence of congenital cerebral palsy.
With congenital cerebral palsy, it is not always easy to identify the cause.

Acquired Cerebral Palsy

The brain continues to develop after birth. While experts debate whether it takes two years, five years or somewhere in between for the brain to fully develop, there is disagreement amongst doctors about whether acquired cerebral palsy begins at 28 days of life, or at the time the baby is born.

The key to understanding the difference between acquired cerebral palsy and congenital cerebral palsy is in identifying the actual cause and when it occurred. In cases of acquired cerebral palsy, it is believed the child was born without the condition, but acquired the brain damage before the brain fully developed. Acquired cerebral palsy is not inherited. Up to 10% of cases are acquired.

It is often easier to identify the actual cause in acquired cerebral palsy than it is in congenital cerebral palsy. Acquired cerebral palsy can be the direct result of brain infections, bacterial meningitis, viral encephalitis, accidents or injuries.

Acquired cerebral palsy can also result from head injury caused by a motor accident, a fall, a near-drowning experience, or abuse. Shaken baby syndrome can result in acquired cerebral palsy if the brain has not yet developed when the injury occurred.

No CP

A case is considered “No CP” if the brain injury occurs after the brain has fully developed—generally, after a child reaches his or her fifth birthday. In cases of No CP, signs of impairment similar to cerebral palsy are diagnosed, but the cause is classified by the type of injury that caused the brain damage – traumatic brain injury, shaken baby, or bacterial meningitis, for example.

While the case is clinically referred to as No CP, the child presenting with signs of cerebral palsy is still treated accordingly. The term No CP allows researchers to include cases of cerebral palsy acquired after birth, but discern between the types more easily. Some researchers prefer to exclude No CP cases from their studies altogether.


CLARIFYING TERMINOLOGY Cause

Because the terminology used is so specific, yet remarkably similar, terms such as brain defect, brain malformation and brain lesion can seem confusing. It is helpful to know the difference between the terms when attempting to understand the cause of cerebral palsy.

Brain development begins shortly after conception. A relatively small number of cells divide and multiply into billions of cells. A small strip of tissue rolls into a neural tube. One end develops into the brain, the other into the spinal cord. Throughout, different types of cells form, group, and migrate to form various regions of the brain. The brain is considered fully developed two to five years after birth.

Brain defects are irregularities in the brain structure that typically cause impairment. Defects can occur from malformation, injury, or disease. The degree of impairment often is linked to the severity of damage. A brain sometimes compensates for defects, in essence, by “rewiring” to bypass or compensate for damaged areas. For this reason, beginning treatment as early as possible is typically recommended.

Brain malformations are defects that occur through abnormal development of the brain. Although defects can occur anytime during fetal development, the first 20 weeks are most vulnerable; any malformation that occurs while the neural tube is forming can have permanent consequences. Brain malformations may result in undeveloped areas, abnormal growth, or improper brain division into hemispheres and lobes.

Brain lesions are defects that occur from injury or disease. Causes during fetal development can include bleeding in the brain, infections, toxins, asphyxia, and many others. Lesions typically result from an incident or event that causes brain tissue death. Holes, which often fill with liquid, are left behind to form cysts.


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