Computed Tomography as an Adjunct in Etiological Analysis of Hemiplegic Cerebral Palsy; II: Children Born at Term

Abstract

CT brain scans were used to evaluate the most likely etiology of hemiplegic cerebral palsy in a group of children born at term. The population based study group comprised 83 children. The CT findings were classified to reflect the phase of brain maturation during which the injury causing hemiplegia most likely had occurred. The most common finding (37%) was periventricular atrophy considered to represent periventricular leukomalacia (PVL). PVL is a form of hypoxic-ischemic damage typical of the immature brain and most commonly seen as a complication of preterm birth. As this lesion was found in children born at term it was considered to reflect a cerebral injury that had occurred in utero. Cerebral maldevelopment, due to a very early intrauterine lesion, was detected in 17%, while cortical-/subcortical lesions, previously considered to be of major importance in hemiplegia, were seen in just 16% of the children. Altogether the CT findings indicated a prenatal origin of hemiplegia in 57%. Assessing the time of injury based on clinical records concurred with prenatal origin in 32% of the children thought to have prenatal origin of hemiplegia by CT. The objective information available from careful review of imaging information such as CT brain scans, is an important adjunct to clinical data. We propose that assessment of brain morphology, by means of imaging, should be integrated with clinical assessment when evaluating the etiology of brain lesions in children with congenital motor impairment.

The role of the cerebral cortex in swallowing

“…Cerebral palsy can be caused by cerebral ischemia, intracranial hemorrhage, or metabolic effects on the brain of preterm and full-term infants [11][12][13]. These events often produce damage to the pyramidal tract, a major output pathway from the motor cortex to the brainstem and cranial nerve motoneurons, as well as to ascending sensory pathways and commissural and association fibers.…”

Practice Parameter: Diagnostic assessment of the child with cerebral palsy [RETIRED]

“…This may vary as one class III study reported that 22.5% of 120 patients had potentially treatable lesions identified (hydrocephalus, porencephaly, arteriovenous malformation, subdural hematomas and hygromas, and a vermian tumor). 10 The majority of other studies reported either no patients with potentially treatable lesions 6,13,14 or lower incidences of 5%, 9 14%, 11 and 17%. 8 On occasion, CT (as well as MRI) may detect abnormalities that suggest a potentially treatable inborn error of metabolism.…”

“…Patients with hemiplegic CP frequently have suffered a prenatal or perinatal cerebral infarction. Data from three CT studies listed in table 3a (n ϭ 196) found cerebrovascular occlusion, usually in the middle cerebral artery distribution, in 13%, 6 32%, 11 and 37% 14 of individuals. There are insufficient data concerning the incidence of cerebral infarction or other causes of cerebrovascular compromise in children with other forms of CP.…”

“…Recent data encompassing a total of 1,426 children who underwent either CT [6][7][8][9][10][11][12][13][14] or MRI [15][16][17][18][19][20][21][22][23][24] scans indicated an abnormality in 62% to 100% of individuals (mean for CT, 77%; for MRI, 89%) (tables 3a and 4a). For the combined CT and MRI class I studies (n ϭ 238), 88% of children had abnormal scans whereas 77% of patients in a class II study (n ϭ 22) had abnormal scans as did 83% of children in the class III studies (n ϭ 1166).…”

Predictive Significance of Magnetic Resonance Imaging at 4 Months of Adjusted Age in Infants after a Perinatal Neurologic Insult

“…Transient periventricular echo densities or periventricular leukomalacia are predictive of impaired neurodevelopmental outcome [1,3,4,[24][25][26] as well as ventricular dilatation and cerebral atrophy [19]. Computed tomography provided more accurate informations about brain damage in children born term and preterm and was considered as a major adjunct to assessment of the injury responsible for cerebral palsy [21,27] as well as an interesting tool for prediction of the later neurodevelopmental outcome [28]. However, MRI has been reported to be more sensitive in determining brain damage than computed tomography and ultrasound in both term and preterm infants [6,7] and especially in depicting the pathological signal intensity in thalami and basal ganglia [23].…”