Hemiplegic cerebral palsy (CP) was studied in a retrospective population‐based series of 169 cases from the South‐westem Swedish health care region covering the birth years 1969‐78. The purpose was to analyse the prevalence, aetiology and neuro‐developmental outcome in children born preterm and at term, and to correlate pathogenetic periods, aetiological factors and clinical parameters to neuroradiology.
The prevalence at the ages 6‐15 years was 0.66 per 1000.
Postnatally acquired hemiplegia, mainly postinfectious, iatrogenic or posttraumatic, constituted 11%. Among term children with congenital hemiplegia (pre and perinatally derived) the aetiology was considered prenatal, mainly circulatory brain lesions and maldevelopments, in 42%, combined pre and perinatal in 9%, perinatal (cerebral haemorrhage, hypoxia) in 16% and untraceable in 34%. The corresponding distribution among preterm children was 29%, 47%, 25% and 6%, respectively. The rate of preterm birth among congenital cases was 24%. Birth asphyxia was shown to be a poor indicator of pathogenetic period, whereas a cascade of postpartum complications suggested perinatal brain damage. Clinical follow‐up of 152 children revealed that 50% had mild, 31 % moderate and 19% severe motor dysfunction. Stereognostic sense was impaired in 44% of the children (astereognosia in 20%). Additional impairments (mental retardation, epilepsy, impaired vision, hearing and speech, severe behavioural/perceptual problems) were present in 42%. Term children with congenital hemiplegia tended to be more severely affected than preterm children. The resulting total handicap was considered mild in 40%, moderate in 44% and severe in 16%. The prevalence of severe total handicap was highest among postnatal cases.
Computerised tomography (CT), performed in 109 congenital cases, was normal in 26%, showed unilateral ventricular enlargement in 36% and revealed cortical/subcortical cavities in 20%. In the remaining 18% CT findings were classified as “other”. With the classification so far used, correlations between CT findings and aetiologies were unsatisfactory and disappointing. In contrast, CT findings showed a strong correlation with clinical degree of severity and magnitude of associated handicap. As a rule, normal CT implied mild disability and unilateral ventricular enlargement moderate, whereas cortical/subcortical cavities were frequently associated with severe handicap, including mental retardation and epilepsy.
