| 제목 |
Grown Cerebral palsy patient with cervical radiculopathy |
| 소속 |
Kwangju Christian Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Na Na Lim1*, Youn Kyung Cho1†, Sung Hoon Lee1, Eun Young Kang1, Hyun Kyung Lee1, Ji Hong Cheon1, Geun Su Lee1, Won Ki Hong1 |
Introduction : As the defenition of cerebral palsy, cerebral palsy patients have a group of "permanent" disorders of the development of movement and posture. They develop secondary musculoskeletal problems as their trunk imblance, gait disturbance. limb spasticity, contractures and joint pain. Once a child is diagnosed as cerebral palsy, he or she regularly goes to the hospital and take intense rehabilitation session. But with aging, cerebral palsy patients' rehabilitation plan tends to be obscure and down sizing. Here, with this very common case, we can consider how much the life time management for the disabled child is important.
Case : Patient A is 53 year old male who was born with prematurity and whose brain imaging showed diffuse encephalomalacia. He has difficulty using all of his limbs because of spastic quadriplegia, His GMFCS Level is V as he use methods of mobility that require physical assistance or powered mobility in most settings. He described both arm radiating pain and motor weakness steadily developing over years. The weaker his arm is, the more difficult to maintain his posture. He and his family decided to take the diagnostic work up including imaging studies, electrodiagnostic exam as well as orthopedic surgery department consultation.
Results : Cervical MRI reveals diffuse bulging diskosteophytes, C4-5, 5-6 and 6-7, modic type II end plate changes, C5, 6, 7 as well as cervical foramen stenosis which led his arm weakness and radiating pain.
In the nerve conduction study, sensory nerve amplitude on both median nerve reveals conduction block and the needle EMG shows diffuse abnormal spontaneous waves on C6 and C7 dermatomes. The amplitude of the positive sharp waves and fibrillation potentials are relatively small suggesting that the lesion has been present for some time. Because of the severe nature of the pain which was not relived by NSAIDs, the patient was referred to the orthopedic surgery for the operative intervention.
Dicussion : Most cerebral palsy patients develop cervical root injury caused by cervical intervertebral disk herniation with spondylitic changes and spondylolytic changes. In this case the patient can control his head and trunk but because of athetoid dystonic movements and rigid scissoring posture he needed total assist for his position change and maintainance. Dystonic athetoid neck movements must have caused excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements might result in early degenerative changes of the vertebrae which may enhance the progress of radiating pain and weakness. Grown cerebral palsy patients are recommended to take regular work up for the musculosckeletal problem as they are at higher risk at musculoskeletal injury and pain. |
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A 53 year old male with cerebral palsy. His cervical MRI reveals diffuse bulging diskosteophytes, C4-5, 5-6 and 6-7. as well as modic type II end plate changes, C5, 6, 7.
Needle EMG reveals relatively small ampitude of fibrillation potentials and positive sharp waves on left biceps brachii(left) and right pronator teres(right)
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