Congenital Hemiplegia: Morphology of Cerebral Lesions and Pathogenetic Aspects from MRI

Abstract

We have analyzed the MRI findings from the brains of 33 children with congenital hemiplegia. Referral of these children to our hospital was either because of neurological problems or a history of complicated birth. According to maturation-dependent pathophysiological mechanisms we have classified the lesions into the following five groups: 1. malformations/prenatal encephalo-clastic lesions, 2. periventricular leukomalacia or atrophy, 3. diencephalic lesions, 4. subcortical and cortical lesions, and 5. normal findings. Combination of lesions was not uncommon. The neuroradiologically most prominent and most expanded lesions determined the classification to the different groups. We detected malformations/encephalo-clastic lesions (Group 1) in 5 children; one of these children also presented additional lesions of Groups 2 and 3. Six children displayed periventricular leukomalacia (Group 2), and in one child in combination with diencephalic and subcortical lesions. Ten children exhibited diencephalic lesions (Group 3), in one case combined with periventricular leukomalacia. The MRI of seven children showed subcortical/cortical lesions (Group 4), in four cases extending into diencephalic structures. Two children had a combination of evenly matched periventricular, diencephalic and subcortical/cortical lesions, where it was impossible to define a principal lesion. Three children had normal MRI findings. Significantly, 8 of 33 children had bilateral lesions although presenting with hemiplegia. The large proportion of diencephalic lesions, not described in similar CT studies, and the small number of normal MRI findings show the value of MRI in evaluation of congenital hemiplegia. The ability to correlate, to some extent, neuroradiological findings of damage to developmental stage affords the conclusion that at least a third of the children in our series with congenital hemiplegia suffered prenatal damage.

Relation between neuroradiological findings and upper limb function in hemiplegic cerebral palsy

“…Other authors have reported on mixed lesions, though without evaluating clinical impairments. 5,24 Results for sensory modalities were less consistent than for motor outcome. In our study, no differences in sensory function were found between main groups, except for exteroception.…”

“…A similar large proportion of bilateral lesions in hemiplegic children with periventricular lesions was reported by others. 5,8,11 A prominent finding was the significantly better motor performance of children in the PVL-group compared to both …”

“…[3][4][5]8 As previously reported by others, 9 children with multiple lesions that could be referred to more than one group were classified according to the assumed most crucial lesion, based on their medical records (information on pregnancy, labour and delivery, birth weight, gestational age, events during the neonatal period and events during further development).…”

“…In congenital hemiplegia, due to pre-or perinatal brain damage, three main lesion types determined by the stage of brain development at the time of the insult have been described: malformations, periventricular lesions and cortical-subcortical lesions. [3][4][5][6][7] The fourth lesion type comprises all types of brain injuries acquired postnatally. 8 Previous attempts have been made to relate the classified lesions to the severity of neurological impairment.…”

Activities of daily living in children with hemiplegic cerebral palsy: a cross-sectional evaluation using the Assessment of Motor and Process Skills

“…27 Although CP is commonly described as a motor impairment, radiological evidence of structural pathology beyond the motor area is common, and bilateral CNS lesions occur in a significant proportion of children with hemiplegic CP. 28,29 It has also been demonstrated that a significant proportion of children show functional impairment in the non-affected hand 30 and, in comparison with healthy age-matched controls, 31 this is associated with bilateral parenchymal lesions on magnetic resonance imaging. 30 It is possible that the extent of the cerebral pathology in hemiplegia could affect process skill ability.…”