CEREBRAL INFANTILE PALSY (As the terminal condition of various diseases of the brain) A number of cerebral affections in childhood, which end neither il:I complete recovery nor in death, leave behind certain anatomical defects and clinical disabilities. A permanent condition results in which the child is healthy except for certain symptoms which remain of the former disease, so that the condition represents not a disease but rather the termination of a disease. This condition IS designated cerebral infantile palsy. According to the strict acceptation of the term it ineludes only cerebral affections in which paralysis of the extremities is the most promi nent symptom, but there are numerous transitional eases which present merely epilepsy, idiocy or atrophy of the optic nerve, and which are recognized as "cerebral palsy without paralysis " (Freud). It is there fore obvious from what has been said. that the diagnosis of cerebral palsy cannot lay any claim to scientific accuracy, and if we wish to be strictly logical and scientific we ought, instead of speaking of cerebral infantile palsy, endeavor to use such terms as the remains of feetal dis eases of the brain, of cerebral hamorrhage or of encephalitis. This, however, is as yet impossible because the same etiologic factors do not always give rise to the same clinical disabilities, so that in a given case, it is impossible even with the aid of the history, to arrive at a definite conclusion with regard to the primary disease. We must therefore content ourselves with the well-defined forms of cerebral infantile palsy and are not justified in tearing down the edifice of cerebral infantile palsy, which has been built up by a number of excellent workmen, until a larger amount of building material than we at present have at our disposal has been collected. The diseases which lead to cerebral infantile palsy or, in other words, the etiology of the disease may be classified as follows: 1. Intra-uterine (prenatal) causes: 'Malformations of the brain and cerebral diseases that are merely concomitants of a general disease (typhoid fever?) or injury to the mother (severe blow on the abdomen).
In this class belong cases of porenceplialus, microeephalus, atrophy of one hemisphere with unilateral diminution in the size of the skull or depression in certain portions of the cranium, congenital cysts, and the like. Clinically these varieties cannot alviays be recognized as such, and the diagnosis is often dependent on the history. But one cannot always rely on the history, as most parents fail to recognize congenital motor disturbances in their children until they first attempt to sit up or walk. Sometimes the presence of some other malformation calls atten tion to the possibility of a congenital disturbance. To what extent congenital poreneephalus and microcephalus are to be regarded as due to arrested development or disease of the brain has already been dis cussed. There are a few eases in the literature which make a relation between intra-uterine traumatism and cerebral infantile palsy probable (Cotard, personal observation). Heredity and alcoholism probably have no etiologic significance; the influence of syphilis has been dis cussed in another place. The theory that emotional excitement during gestation may have an influence on the child's central nervous system is scarcely tenable.
2. Birth injuries (natal, intrapartum causes). These are chiefly intermeningeal htemorrhages (see section on traumatic diseases of the central nervous system). The term Little's disease is employed by many writers, as he was the first to describe this important cause of numerous cases of cerebral infantile palsy. An intrapartutn injury may be assumed a priori if the labor was difficult, or the child was born in asphyxia, or convulsions developed soon after birth. Even when the labor has not been difficult, especially if it was precipitate, intra cerebral hxmorrhage is possible. Cases of cerebral palsy occurring after premature deliveries may possibly be explained in this way.