Cerebral Palsy Case Scenarios

Scenarios of Cerebral Palsy Patients

Scenario 1: Spastic Diplegia in a Child

A 6-year-old boy is brought to the clinic by his mother due to walking difficulty. He was born prematurely at 30 weeks and stayed in the NICU for one month. He started walking at age 3 and walks on tiptoes with scissoring of the legs. On examination, he has increased tone and brisk reflexes in both lower limbs, but normal upper limb function. His intelligence is average.

➡️ Likely Diagnosis: Spastic Diplegic Cerebral Palsy
➡️ Management Focus: Physiotherapy, orthotics, botulinum toxin, gait training

Scenario 2: Quadriplegic CP with Feeding Issues

A 4-year-old female with a known history of hypoxic birth injury presents with severe motor delays. She cannot sit without support and has poor head control. She also has difficulty swallowing and frequent episodes of choking while feeding. Her limbs are stiff, and her fists remain tightly closed. She is nonverbal.

➡️ Likely Diagnosis: Spastic Quadriplegic Cerebral Palsy
➡️ Management Focus: Swallowing therapy, nutritional support (PEG), physiotherapy, speech therapy

Scenario 3: Hemiplegic CP and Early Hand Preference

A 2-year-old child is noted to use only the right hand for most tasks, even though he is right-handed. The left hand remains flexed and is not used during play. Parents also report delayed walking. On exam, the child has increased tone in the left arm and leg, with reduced fine motor control on the affected side.

➡️ Likely Diagnosis: Spastic Hemiplegic Cerebral Palsy
➡️ Management Focus: Occupational therapy, physiotherapy, constraint-induced movement therapy

Scenario 4: Ataxic CP with Coordination Problems

A 10-year-old boy with a history of neonatal cerebellar insult has trouble with balance and coordination. He walks with a wide-based gait and often falls. He also has difficulty with handwriting and tasks requiring fine motor skills. There is no significant spasticity.

➡️ Likely Diagnosis: Ataxic Cerebral Palsy
➡️ Management Focus: Balance training, occupational therapy, adaptive aids

Scenario 5: Dyskinetic CP with Choreoathetoid Movements

A 7-year-old girl has involuntary writhing movements, especially of the face and upper limbs. Her speech is slurred, and she drools frequently. These symptoms worsen with excitement or stress. She had severe neonatal jaundice requiring exchange transfusion.

➡️ Likely Diagnosis: Dyskinetic (Athetoid) Cerebral Palsy due to Kernicterus
➡️ Management Focus: Speech therapy, oral motor exercises, medications (e.g., anticholinergics, baclofen)

Scenario 6: CP with Intellectual and Behavioral Challenges

An 8-year-old boy with spastic diplegia attends a special education school. He has moderate intellectual disability and aggressive outbursts. He uses a wheelchair and wears ankle-foot orthoses. His parents are concerned about his behavior and social interaction.

➡️ Likely Diagnosis: CP with coexisting intellectual disability and behavioral disorders
➡️ Management Focus: Psychological evaluation, behavior therapy, special education support

Scenario 7: Adolescent with CP and Contractures

A 15-year-old boy with spastic quadriplegia has developed fixed contractures in both knees and hips. He has outgrown his wheelchair and complains of hip pain. He is nonverbal but communicates via eye gaze. His scoliosis has worsened.

➡️ Likely Diagnosis: Long-term complications of severe CP (contractures, scoliosis)
➡️ Management Focus: Orthopedic surgery consult, wheelchair reassessment, spasticity management

Scenario 8: CP with Seizure Disorder

A 5-year-old male with spastic hemiplegic CP presents with recurrent seizures. His seizures began at age 3 and are partially controlled on medication. He attends mainstream school but struggles with concentration.

➡️ Likely Diagnosis: CP with epilepsy
➡️ Management Focus: Antiepileptic drugs, developmental assessment, educational support

Scenario 9: Mild CP with Good Functional Mobility

A 12-year-old girl with a history of preterm birth has mild spastic diplegia. She can walk independently but has difficulty running or climbing stairs. She has mild ankle tightness and uses night splints. She is doing well in regular school.

➡️ Likely Diagnosis: Mild CP with good prognosis
➡️ Management Focus: Physiotherapy, stretching, possible orthopedic follow-up

Scenario 10: CP in a Resource-Limited Setting

A 6-year-old boy with quadriplegic CP lives in a rural area with limited access to rehabilitation services. He is cared for by his grandmother. He spends most of the time lying on a mat. No assistive devices or therapy have been provided.

➡️ Likely Diagnosis: Under-managed CP due to limited resources
➡️ Management Focus: Community-based rehabilitation, caregiver education, donation of assistive devices