Causes of Cerebral Palsy: Origins, Etiology, Aetiology, Causal Pathways
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Oxygen Shortage & AsphyxiaCerebral PalsyCerebral Palsy Cerebral Palsy Cerebral Palsy Cerebral Palsy Cerebral Palsy

“Before accepting a diagnosis of birth asphyxia, evidence is required of the presence of (1) hypoxia; followed by (2) decompensatory fetal response(s) indicating that the severity of hypoxia had exceeded the adaptive capacity of the fetus; (3) neonatal encephalopathy; and (4) a probable causal link between the encephalopathy and the hypoxia. This probability is enhanced if there is no evidence of a preexisting neurological deficit.”

-Stanley, Blair & Alberman

Cerebral Palsy

Cerebral Palsy
Loss of oxygen in the infant immediately before or during birth can be caused by several different events including, in the mother, acute maternal hypotension, ruptured vasa previa, uterine rupture, cardiac complications, intrapartum hemorrhage, trauma. In addition there can be damage to the baby due to cephalophelvic disproportion, abnormal presentation, shoulder dystocia, premature placental separation, and umbilical cord complications such as prolapsed cord. A fragile organ (the brain) at a difficult time (birth) can be exposed to impaired blood flow, blood with less oxygen (from poorly functioning lungs), and there can be pressure to the cranium changing its shape causing bleeding or decreasing blood flow to undamaged areas.

“When CP is diagnosed in childhood, it is often found that the child suffered asphyxia at birth. The asphyxia, however, is often considered the symptom of an otherwise sick baby with a neurological problem, not the primary cause of CP. In two different large studies, only about 9 percent of children with CP were thought to have CP directly and exclusively related to asphyxia at delivery. Ninety-one percent of babies had other inherent causes that led to prematurity or neonatal problems (problems occurring at birth or right after birth). This is apparently why the incidence of CP in undeveloped and poverty-stricken countries, where infant mortality is very high, is the same as in northern Europe, where infant mortality is the lowest in the world. It may also explain why modern obstetrical care, including monitoring and high rate of Cesarean section, has lowered infant mortality rates but not the incidence of cerebral palsy. Many more premature infants are surviving the first few weeks and months of life than was true in the past.” (Miller & Bachrach, p.10)

Apgar scores are used to determine the vulnerability of an infant to cerebral palsy and severe birth trauma. Respiration, heart rate, muscle tone, skin color and motor reaction time are evaluated to determine an Apgar score. The lower the score, the greater the risk. A score of 3, 20 minutes after birth gives an infant a 250 times greater risk than a normal score and suggests the possibility of severe asphyxia. Only half of the infants with such high Apgar scores 20 minutes after birth develop cerebral palsy. This calls attention to the difficulty of associating the events at birth with asphyxia with specific outcomes.

Matching events on a cellular level during a traumatic birth such as cerebral oxygenation, neuronal cell death and compensatory cerebral metabolism with observable details such as the appearance of meconium, postnatal metabolic acidosis, neonatal encephalopathy and infant physiological dysfunction are not easy correlates. This is profoundly complicated by possible established but unobserved cofounders or hidden variables noted on the other pages of this website such as infection, genetic issues, the mother’s state of health, etc.

Periventricular leukomalacia (PVL) describes cell death in the white matter of the brain beside the lateral ventricles and can result from both reduced blood oxygen and brain blood flow and is associated with reduced use of the legs. Intrventricular hemorrhage (IVH) is bleeding into the ventricles. Periventricular leukomalacia (PVL) and intrventricular hemorrhage (IVH) are two conditions that can result in hypoxia, yet it is often difficult to estimate if cerebral palsy will result: a relatively small area of damage may result in long term physical repercussions and visa versa. Both MRI or cranial ultrasound provide results which are relied upon to make these evaluations. Cerebral Palsy is diagnosed when the symptoms appear, not when the damage is evaluated to occur.


Miller, Freeman & Bachrach, Steven J. (1995) Cerebral Palsy: A Complete Guide for Caregiving. The John Hopkins University Press

Stanley, Fiona, Blair, Eve, Alberman, Eva. (2000) Cerebral Palsies: Epidemiology & Causal Pathways. Mac Keith Press

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Causes of Cerebral Palsy: Origins, Etiology, Aetiology, Causal Pathways