Evaluation of neuroimaging in cerebral palsy

ObjectiveCerebral palsy (CP), a common static motor neurological disorder of childhoodwith wide spectrum of underlying etiologies, can be demonstrated withdifferent neuro imaging techniques. We undertook this study to investigatethe diagnosis of intracranial lesions in children with CP and its correlationbetween clinical deficits and neuroradiological findings.Materials and methodsIn this prospective hospital-based study, the data of 120 patients with CP,aged below 18 years, referring to the neurology clinic of the Ali AsgharPediatric hospital in Tehran was studied; data on their cranial neuroimagingfindings was analyzed any possible association(s) between the gestationalages, prenatal history and neurological deficits were investigated.ResultsOf the 120 patients, 72 (60%) were male; 75% were aged below 7 years.Common predisposing factors were prenatal asphyxia, LBW, prematurityand toxemia of pregnancy. Of the 120 cases, 90%(107) had spastic CP, withthe quadriplegic type being the most common (54%), followed by spasticparaplegia (21%); twenty-four patients (20%) had significant PreventricularLeucomalacia (PVL), a finding more common among those born pre-term.Sixteen patients had hemiplegic CP, 14 of whom showed unilateral lesionson brain MRI imaging. Ten (8%) had extra pyramidal CP, a condition morecommon among term born infants, while six of the 10(72%) showed significantabnormalities on the basal ganglia. Cerebral atrophy was seen in 60 (50%) ofpatients and PVL in 20%; encephalomalacia, gliosis, middle cerebral arteryinfarcts, PVL and gliosis indicated hypoxia as a risk factor for CP. Extent ofMRI lesions correlated with the severity of neurological deficits in CP lesions,which were more extensive in Quadriplegics and double hemiplegics ratherthan paraplegics, and among those delivered preterm as compared to thoseborn at term.ConclusionRadiological findings were found to be closely related to the type of CP andthe neurological deficits and gestational ages of patients with brain insult;we believe that MRI is helpful in delineating the underlying etiology, extent,severity and timing of insult to the developing brain and prognostication in