Mimics of cerebral palsy

Cerebral palsy (CP) is the commonest cause of movement disorder in childhood, with an incidence of around 1 in 400 live births. Many other conditions can masquerade as CP in their clinical presentation, particularly in the early stages. Neuroimaging is often a helpful tool in discriminating CP from other conditions, where characteristic patterns of damage and/or developmental changes are described. However, epidemiological reports consistently report that imaging is normal in up to 15% of children with established CP. Such cases need to be carefully distinguished from other metabolic and genetic conditions, which may also show normal imaging or only slowly evolving change. This article highlights features that may point to an underlying genetic or metabolic disease rather than the static insult that defines causation in CP and suggests an approach to examination and investigation.