PE27.5 | Infantile Hemiplegia — Summary & Reflection

KEY TAKEAWAYS

Infantile hemiplegia is unilateral upper motor neurone deficit acquired before age 2 years, usually representing hemiplegic cerebral palsy. Key causes are prenatal (cortical dysplasia, prenatal MCA stroke, PVL) and perinatal (neonatal arterial ischaemic stroke, asymmetric HIE). The hallmark early sign is asymmetric hand preference before 12 months. Neurological examination reveals contralateral spasticity, hyperreflexia, and a positive Babinski sign. CP is classified by motor type (spastic most common) and topography; GMFCS I–V quantifies functional ability. Associated comorbidities — epilepsy (35–40%), cognitive impairment, sensory loss, visual field defect, and orthopaedic sequelae — require systematic surveillance. MRI brain is the investigation of choice. Management is multidisciplinary: CIMT and physiotherapy for upper-limb function; botulinum toxin for spasticity; AEDs for seizures (weight-based dosing; avoid carbamazepine in myoclonic components); hemispherotomy for drug-resistant epilepsy with a clear unilateral lesion; orthopaedic interventions for contractures and hip.

REFLECT

Consider the 10-month-old from our opening scenario. His mother asked: 'Will he ever use his hand normally?' Reflect on: What information would you gather during the consultation to give her an honest, individualised prognosis? Which GMFCS level might you assign today, and what does that predict for his functional independence at school age? How would you explain neuroplasticity and CIMT to a non-medical parent in simple terms — what analogy would you use? Consider too the emotional impact on the family of this diagnosis, and how a Kolb-style 'concrete experience → reflective observation → abstract conceptualisation → active experimentation' learning cycle mirrors the therapeutic approach you will take with this child over years of follow-up.