Cerebral palsy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Cerebral Palsy from other Diseases

  • Cerebral Palsy must be differentiated from other slowly progressive diseases such as neurodegenerative disease or metabolic disorders.
  • Presence of any of the following factors may suggest an alternative diagnosis:[1]
    • Family history of any CNS disease
    • Progressive worsening of neurological symptoms
    • Symptoms worsened during stress such as illness or fasting
    • Absence of any specific risk factor causing cerebral palsy
    • Hypotonia with weakness
    • Failure to develop milestones normally
    • Clinical findings such as muscle atrophy, ataxia, sensory disturbances and involuntary movements
  • Cerebral Palsy must be differentiated from
    • Inherited Metabolic Disorders Overview
    • Intellectual Disability
    • Metabolic Myopathies
    • Metabolic Neuropathy
    • Traumatic Peripheral Nerve Lesions
    • Tumors of the Conus and Cauda Equina
    • Vascular Malformations of the Spinal Cord
  • As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Preferred Table

Diseases Type of motor abnormality Clinical findings Laboratory findings and diagnostic tests Radiographic findings
Spasticity Hypotonia Ataxia Dystonia
Leigh syndrome - - + +
  • Progressive psychomotor regression
  • Seizures
  • External ophthalmoplegia
  • Lactic acidosis
  • Vomiting
  • Increased lactate levels in blood and CSF
  • Genetic testing
  • MRI: abnormal white matter signal in the putamen, basal ganglia, and brainstem on T2 images

Niemann-Pick disease type C - - + +
  • Progressive neurodegeneration
  • Hepatosplenomegaly
  • Systemic involvement of liver, spleen, or lung precedes neurologic symptoms
  • Abnormal liver function tests
  • Fibroblast cell culture with filipin staining
  • MRI:

    • cerebral and cerebellar atrophy

    • thinning of the corpus callosum

Infantile Refsum disease - + + -
  • Abnormalities of the optic nerve and disc
  • Retinitis pigmentosa
  • Sensorineural hearing loss
  • Hepatomegaly and cirrhosis
  • Neurologic deterioration is slower than in Zellweger syndrome or ALD
Elevated plasma VLCFA levels
Adrenoleukodystrophy + - - -
  • Cognitive and behavioral abnormalities
  • Adrenal insufficiency
  • Hyperpigmented skin
  • Gonadal dysfunction
  • Neurologic deterioration progresses at a variable rate
  • Elevated plasma VLCFA levels
  • Molecular genetic testing for mutations in the ABCD1 gene
Zellweger syndrome - + - -
  • Craniofacial dysmorphism
  • Hepatomegaly
  • Neonatal seizures
  • Profound developmental delay
  • MRI findings include cortical and white matter abnormalities
  • Neurologic deterioration is rapid and infants rarely survive beyond six months of age
  • Elevated plasma VLCFA levels
  • Elevated levels of phytanic acid, pristanic acid, and pipecolic acid in plasma and fibroblasts
  • Reduced plasmalogen in erythrocytes
  • Molecular genetic testing for mutations in the PEX1 or PEX6 genes
Pyruvate dehydrogenase deficiency + + + -
  • Lactic acidosis
  • Seizures
  • Intellectual disability
  • Elevated lactate and pyruvate levels in blood and CSF
  • Abnormal PDH enzymatic activity in cultured fibroblasts
Arginase deficiency + - - -
  • Hyperammonemia
  • Encephalopathy
  • Respiratory alkalosis
  • Elevated ammonia level
  • Elevated arginine level
Holocarboxylase synthetase deficiency - + - -
  • Ketoacidosis
  • Dermatitis
  • Alopecia
  • Seizures
  • Developmental delay
Elevated levels of:
  • Beta-hydroxyisovalerate
  • Beta-methylcrotonylglycine
  • Beta-hydroxypropionate
  • Methylcitrate
  • Tiglylglycine
Glutaric aciduria type 1 - - - +
  • Episodes of metabolic decompensation and encephalopathy often precipitated by infection and fever
  • Rarely presents in the newborn period
  • Microencephalic macrocephaly
  • Seizures (approximately 20 percent)
  • Cognitive function is preserved
Elevated levels of:
  • glutaric acid
  • 3-hydroxyglutaric acid
  • MRI : frontal and temporal atrophy

References

  1. Gupta R, Appleton RE (2001). "Cerebral palsy: not always what it seems". Arch. Dis. Child. 85 (5): 356–60. PMC 1718969. PMID 11668092.

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