Diagnosis and Management of Congenital Hemiparesis

Primary Diagnosis and Investigations

The American Academy of Pediatrics recommends that unilateral spastic cerebral palsy (hemiplegic CP) is the most likely diagnosis, which accounts for 38% of all CP cases and typically presents with congenital hemiparesis and foot drop 1
MRI brain is the single most critical investigation and should be performed immediately, as it has 86-89% sensitivity for detecting CP and provides both diagnostic and prognostic information 1, 2
The Hammersmith Infant Neurological Examination (HINE) should be performed immediately, as it has 90% predictive value for CP at ages 2-24 months 1, 2

The Developmental Assessment of Young Children (DAYC) should be administered, as it has 89% predictive value for CP and quantifies motor delay 1, 2
Alternative assessments include the Alberta Infant Motor Scale (AIMS) with 86% predictive value, or the Movement Assessment of Infants (MAI) with 73% predictive value 2
Perinatal risk factors, such as conception, pregnancy, birth complications, and postneonatal period events, should be elicited, as the complete causal path is unclear in 80% of cases, but risk factors are often identifiable 1

The diagnosis of CP or high risk of CP must always include screening for common comorbidities, such as vision, hearing, hip surveillance, epilepsy, sleep disorders, and feeding/swallowing assessment, as these significantly impact quality of life and require early intervention 1, 2, 4
Vision assessment should have been performed in the first 48 hours of life, and if abnormal at term-equivalent age, requires vision intervention and reassessment at 3 months, as functional blindness affects 11% of CP cases 1, 4
Hearing screening is necessary, as hearing impairment affects 4% of CP cases 1, 4

Early intervention must begin immediately upon diagnosis or suspicion, as delaying intervention causes harmful, progressively irreversible modifications to muscle and bone growth 4
Constraint-Induced Movement Therapy (CIMT) should be started immediately for unilateral CP, as early interventions differ for unilateral versus bilateral CP 2, 3
Ankle-foot orthosis (AFO) should be prescribed immediately for foot drop to improve gait mechanics, prevent contractures, and enhance mobility 3