Cerebral Palsy maybe/maybe not

One patient was strangling herself with her right arm locked down tight behind her neck. It was massively forceful beyond anybody’s ability to dislodge it. The plan was have an orthopedist break the arm (in a nice way?) to allow intubation. She is quite purple. Injecting local anesthetic into her crooked left middle finger (which she fractured on a plunging communication board hit), ended the medical emergency as the right arm simply on its own came to her right side, relaxed. Another dystonia feature – maddening – is that because the origin is from high mid-brain, it isn’t experienced as an imposed abnormality. It is felt to be choice. ‘Dystonic patients will often seek abnormal postures against treatments that thwart them. They kind of live in curved space. Rigidity - is another kind of stiffness wherein, again, the stiffness of one joint is related to the posture of the next joint. Thus an ankle very rigidly pointed downward at an extreme and feeling like stone, suddenly points upward when the knee is flexed. Likewise the hip responds to knee position or the reverse. We see thrust or withdraw patterns to these associations which stem from the mid-brain primitive circuits intact without higher level inhibition. But these are not zigzag and if correction pressure is manually applied and held, the rigidity will suddenly just melt away. Athetosis - is an oscillating rhythmic movement of the limbs often associated with extremes of twisting facial movements, though not always. A very specific area in the brain (basal ganglia) does this when injured. It can be injured by high bilirubin (jaundice) levels. Today that is rare, although we have seen it increase in the wake of drive by birthing, as the detection skills at home may be wanting.