Evaluation of Neuroimaging in Cerebral Palsy

Objective

Cerebral palsy (CP), a common static motor neurological disorder of childhood with wide spectrum of underlying etiologies, can be demonstrated with different neuro imaging techniques. We undertook this study to investigate the diagnosis of intracranial lesions in children with CP and its correlation between clinical deficits and neuroradiological findings.

Materials and methods

In this prospective hospital-based study, the data of 120 patients with CP, aged below 18 years, referring to the neurology clinic of the Ali Asghar Pediatric hospital in Tehran was studied; data on their cranial neuroimaging findings was analyzed any possible association(s) between the gestational ages, prenatal history and neurological deficits were investigated.

Results

Of the 120 patients, 72 (60%) were male; 75% were aged below 7 years. Common predisposing factors were prenatal asphyxia, LBW, prematurity and toxemia of pregnancy. Of the 120 cases, 90%(107) had spastic CP, with the quadriplegic type being the most common (54%), followed by spastic paraplegia (21%); twenty-four patients (20%) had significant Preventricular Leucomalacia (PVL), a finding more common among those born pre-term.

Sixteen patients had hemiplegic CP, 14 of whom showed unilateral lesions on brain MRI imaging. Ten (8%) had extra pyramidal CP, a condition more common among term born infants, while six of the 10(72%) showed significant abnormalities on the basal ganglia. Cerebral atrophy was seen in 60 (50%) of patients and PVL in 20%; encephalomalacia, gliosis, middle cerebral artery infarcts, PVL and gliosis indicated hypoxia as a risk factor for CP. Extent of MRI lesions correlated with the severity of neurological deficits in CP lesions, which were more extensive in Quadriplegics and double hemiplegics rather than paraplegics, and among those delivered preterm as compared to those born at term.

Conclusion

Radiological findings were found to be closely related to the type of CP and the 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 CP patients.