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Difficulty: EasyPediatric Neurologic Disorders

A 15-month-old girl is brought to the clinic for a well-child visit. She was born prematurely at 28 weeks of gestation. The parents are concerned because she is not yet walking independently and her legs often seem 'stiff' when changing her diaper. On physical examination, there is increased muscle tone, hyperreflexia, and sustained clonus in both lower extremities. She stands on her toes when supported. The pediatrician suspects spastic diplegic cerebral palsy. Which of the following statements regarding this patient's clinical presentation and development are accurate? (Select all that apply.)

  1. Prematurity is a major risk factor for developing this type of motor impairmentAnswer
  2. The findings of hyperreflexia and increased muscle tone are characteristic of an upper motor neuron lesionAnswer
  3. C
    Her inability to walk independently at 15 months of chronological age confirms a severe pathologic motor delay
  4. D
    The absence of the Moro reflex on this patient's physical examination suggests an ongoing neurodegenerative process
  5. E
    Her inability to speak in three-word sentences during this visit represents a profound language delay

Answer

The correct statements are that prematurity is a major risk factor for developing this type of motor impairment, and the findings of hyperreflexia and increased muscle tone are characteristic of an upper motor neuron lesion.
The correct statements correctly highlight fundamental aspects of spastic diplegic cerebral palsy. Prematurity, particularly birth before 32 weeks of gestation, is the most significant risk factor for cerebral palsy due to the vulnerability of the periventricular white matter. Additionally, findings such as increased muscle tone, hyperreflexia, and sustained clonus are classic signs of an upper motor neuron lesion, which forms the underlying pathology of this disorder.

Step-by-Step Solution

1
Identify the suspected clinical condition.
The patient is a premature infant presenting with hypertonia, hyperreflexia, and sustained clonus in the lower extremities, which are classic signs of spastic diplegic cerebral palsy.
Understanding the clinical presentation is necessary to evaluate the pathophysiology and risk factors.
2
Evaluate the risk factors and neurological signs.
Prematurity is confirmed as the leading risk factor for cerebral palsy. The physical exam findings are confirmed as signs of an upper motor neuron lesion.
This confirms the accuracy of the two correct statements.
3
Assess the developmental milestones using corrected age for the premature infant.
A 15-month-old born at 28 weeks has a corrected age of 12 months. Not walking at 12 months, lacking a Moro reflex (normally gone by 6 months), and not speaking three-word sentences (expected at 3 years) are all normal findings for her age.
This step is required to identify why the remaining distractors inaccurately label normal development as pathological.

Key Concept

Cerebral palsy is strongly associated with prematurity and presents with upper motor neuron signs. Furthermore, assessing developmental milestones in premature infants requires adjusting for corrected age to avoid misidentifying normal progress as delayed.
Estimated Time:1m 0s
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Pediatric Neurologic Disorders

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