Etiology

The insult resulting in cerebral palsy can be prenatal, natal, or postnatal. Specific etiologies that are associated with cerebral palsy include:

• 50%: Birthweight
• 10-20%: Intrapartum asphyxia
• 10-18%: Postnatal 
• 12-30%: Other causes (brain malformation, arteriovenous malformation, unknown, etc) 

Prenatal disorders that can result in cerebral palsy include congenital brain lesions (eg, arteriovenous malformations), intrauterine infections with a variety of organisms (eg, cytomegalovirus, rubella, Toxoplasma gondii), hemolytic disease of the newborn (Rh/ABO), or fetal anoxia from whatever causes. Abnormalities of coagulation (eg, antiphospholipid antibodies) may also be responsible for some cases.

Alternately, maternal disorders such as substance abuse, metabolic disturbances, and mental retardation are also associated with the development of cerebral palsy in some newborns. Problems at the time of delivery such as prematurity, trauma, hypoxic-ischemic encephalopathy, and infection are also linked to the development of cerebral palsy.

During the postnatal period, a variety of disorders can result in the development of cerebral palsy. These include hypoxia and acidosis, infection (eg, meningitis, encephalitis, sepsis), traumatic head injuries and toxins such as lead. In some instances, the exact timing and etiology are unknown.

Ref: Nelson KB, Dambrosia JM, Grether JK, et al. Neonatal cytokines and coagulation factors in children with cerebral palsy. Ann Neurol 1998;44:665-75.