[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Cerebral palsy

[Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/)

# Cerebral palsy

Cerebral palsy is a group of lifelong movement and posture disorders caused by damage to the developing brain. It does not get worse, but needs ongoing therapy.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/)
- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)
- [Caudate nucleus](https://durgical.com/en/anatomy/caudate-nucleus/)
- [Lateral ventricles](https://durgical.com/en/anatomy/lateral-ventricle/)
- [Putamen](https://durgical.com/en/anatomy/putamen/)
- [Globus pallidus](https://durgical.com/en/anatomy/globus-pallidus/)
- [Thalamus](https://durgical.com/en/anatomy/thalamus/)
- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)

## In embryology

- [Fetal lung, kidney and brain maturation: what preterm birth interrupts](https://durgical.com/en/embryology/fetal-lung-kidney-and-brain-maturation-what-preterm-birth-interrupts/)
- [Microcephaly](https://durgical.com/en/embryology/microcephaly/)

## In the clinical exam

- [Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling](https://durgical.com/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/)

## Why it happens

- [Watershed areas and the organs most sensitive to ischemia](https://durgical.com/en/general-pathology/watershed-areas-and-the-organs-most-sensitive-to-ischemia/)
- [Upper versus lower motor neuron lesions](https://durgical.com/en/physiology/upper-versus-lower-motor-neuron-lesions/)
- [Motor cortex and the corticospinal tract](https://durgical.com/en/physiology/motor-cortex-and-the-corticospinal-tract/)
- [Basal ganglia and movement control](https://durgical.com/en/physiology/basal-ganglia-and-movement-control/)

## What it is

A group of permanent disorders of movement and posture caused by a non-progressive injury or malformation of the developing fetal or infant brain. It is the most common cause of physical disability in childhood.

## Who gets it

Occurs in about 2 per 1,000 live births worldwide. Prematurity and low birth weight are the strongest associations; in Colombia and Latin America, neonatal infections, perinatal asphyxia, kernicterus and limited access to early intervention also contribute.

## Causes

- Most cases (about 85–90%) are congenital: the injury happens before or during birth, often without a single identifiable cause
- Periventricular leukomalacia and intraventricular haemorrhage in preterm infants
- Perinatal hypoxic-ischaemic encephalopathy (a minority of cases)
- Congenital infections (cytomegalovirus, toxoplasmosis, rubella, Zika) and brain malformations
- Kernicterus from severe neonatal hyperbilirubinaemia
- Acquired after the neonatal period: meningitis, head injury (including abusive head trauma), near-drowning

## Risk factors

- Preterm birth and low birth weight
- Multiple pregnancy
- Maternal infection, chorioamnionitis or thyroid disease
- Neonatal stroke, seizures or severe jaundice

## Pathophysiology

Damage to motor pathways in the immature brain disrupts control of tone and movement. Injury to the corticospinal tracts ([motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) and periventricular white matter) produces spasticity; injury to the basal ganglia gives dyskinetic forms; injury to the [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) gives ataxia. The lesion itself does not progress, but muscle contractures, hip dislocation and scoliosis develop with growth.

## Classification

- Spastic (about 80%): hemiplegia, diplegia (legs more than arms, typical of prematurity) or quadriplegia
- Dyskinetic: dystonia or choreoathetosis (basal ganglia, classically kernicterus or severe asphyxia)
- Ataxic: poor balance and coordination (cerebellum)
- Mixed forms
- Severity by the Gross Motor Function Classification System (GMFCS levels I–V)

## Symptoms and signs

- Delayed motor milestones (not sitting, crawling or walking at expected ages)
- Increased tone with brisk reflexes, clonus and persistent primitive reflexes; or low tone in early infancy
- Early hand preference before 12 months (suggests hemiplegia)
- Toe walking or scissoring gait
- Feeding and swallowing problems, drooling
- Associated conditions: epilepsy, intellectual disability, visual and hearing impairment, speech disorders

## Red flags

- Loss of previously acquired skills (regression), which suggests a progressive neurological or metabolic disease rather than cerebral palsy
- Choking, coughing with feeds or recurrent pneumonia (aspiration)
- Hip pain or reduced hip abduction (hip subluxation)
- Prolonged seizures
- Pressure injuries or poor weight gain

## Diagnosis

**Clinical**
A clinical diagnosis based on history (pregnancy, birth, neonatal course) and a neurological examination of tone, reflexes, posture and milestones. Standardised tools such as the Hammersmith Infant Neurological Examination and General Movements Assessment allow diagnosis or high-risk designation in early infancy.

**Tests**
Metabolic and genetic testing when there is no clear perinatal cause, a family history or regression. EEG if seizures are suspected; hearing and vision assessment.

**Imaging**
Brain MRI is the imaging of choice and shows the lesion in most children (periventricular [white matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/) injury, basal ganglia or cortical lesions, malformations); cranial ultrasound in preterm newborns. Hip radiographs for surveillance.

## Differential diagnosis

- Neurodegenerative and metabolic disorders (leukodystrophies, mitochondrial disease)
- Spinal muscular atrophy and muscular dystrophies
- Hereditary spastic paraplegia
- [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) lesions or tumours

## Goal of treatment

Maximise function, independence, communication and participation, prevent contractures and hip dislocation, and treat associated problems, through a multidisciplinary team that supports the family.

## Treatment

**Rehabilitation**
Early intervention with physiotherapy, occupational therapy and speech therapy; orthoses, mobility aids and communication devices.

**Medical**
Spasticity treatment with oral muscle relaxants (e.g. baclofen), botulinum toxin injections to selected muscles or intrathecal baclofen; antiseizure drugs for epilepsy.

**Surgical**
Orthopaedic surgery (tendon lengthening, hip and [spine](https://durgical.com/en/anatomy/region/spine/) procedures) and, in selected children, selective dorsal rhizotomy.

**Follow-up**
Nursing priorities: nutrition and safe swallowing, aspiration prevention, [skin](https://durgical.com/en/anatomy/skin/) care and repositioning, hip and spine surveillance, and support for caregivers.

## Complications

- Muscle contractures and joint deformities
- Hip subluxation and dislocation; scoliosis
- Aspiration pneumonia and malnutrition
- Epilepsy
- Osteopenia and fractures
- Pain, pressure injuries and constipation

## Prognosis

Lifelong but non-progressive. Most children with mild forms walk and attend regular school; survival is shortest in those with severe motor impairment, feeding problems and epilepsy, mainly from respiratory causes. Function at age 2 helps predict walking ability.

## Prevention

- Good prenatal care and prevention of preterm birth
- Antenatal magnesium sulphate for women at risk of very preterm birth (neuroprotection)
- Therapeutic hypothermia for term newborns with moderate to severe hypoxic-ischaemic encephalopathy
- Prevention and treatment of severe neonatal jaundice; rubella vaccination

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common type of cerebral palsy?

Spastic cerebral palsy, about 80% of cases.

## Which type of cerebral palsy is typical of preterm infants with periventricular leukomalacia?

Spastic diplegia, with the legs more affected than the arms.

## Which finding suggests a diagnosis other than cerebral palsy?

Loss of acquired skills (regression), since cerebral palsy is non-progressive.

## What is the imaging study of choice in suspected cerebral palsy?

Brain MRI.

## Which neonatal condition causes dyskinetic cerebral palsy through basal ganglia injury?

Kernicterus from severe hyperbilirubinaemia (also severe hypoxic-ischaemic injury).

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/cerebral-palsy/)

## Related conditions

- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- [Hydrocephalus](https://durgical.com/en/conditions/hydrocephalus/)
- [Bacterial meningitis](https://durgical.com/en/conditions/bacterial-meningitis/)
- [Scoliosis](https://durgical.com/en/conditions/scoliosis/)
- [Hip dislocation](https://durgical.com/en/conditions/hip-dislocation/)
- [Strabismus and amblyopia](https://durgical.com/en/conditions/strabismus-and-amblyopia/)
- [Neonatal jaundice](https://durgical.com/en/conditions/neonatal-jaundice/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [About Cerebral Palsy](https://www.cdc.gov/cerebral-palsy/about/index.html) (Centers for Disease Control and Prevention (CDC), 2026).

[← All conditions](https://durgical.com/en/conditions/)

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/conditions/cerebral-palsy/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/cerebral-palsy/