Computed Tomographic Findings in Congenital Hemiparesis in Childhood and Their Relation to Etiology and Prognosis

Abstract

40, 1-14-year-old children suffering from congenital hemiparesis were re-examined neurologically and admitted to CT. According to our morphological results we found three different types of CT patterns: 1. unilateral enlargement of the lateral ventricle or parts of it (20 patients), 2. cavity in the cortex and subcortical white matter within the supply area of the middle cerebral artery (17 patients), 3. normal CT scans (3 patients). Patients with a cortical and subcortical cavity consistently had a moderate to severe hemiparesis and suffered more often from epilepsy and intellectual impairment than patients with unilateral ventricular enlargement and those with normal CT findings. Most patients with cortical defects had a history of perinatal complications, while abnormal pregnancies and prematurity prevailed in patients with unilateral ventricular enlargement. We believe that a cavity in the cortex and subcortical white matter is of arterial-ischemic origin, whereas unilateral ventricular enlargement with destruction of the deep white matter is related to venous hemorrhage. But it must be emphasized that CT cannot detect the causes, mechanisms and timing of the underlying brain lesions in congenital hemiparesis.

Hemiparetic cerebral palsy: clinical data compared with neuroimaging

“…The brain pathology types and their relative frequencies were similar to those found in other hemiparetic cerebral palsy studies 19,18,16,12 . In addition, bilateral lesion was found in three out of the 23 patients.…”

Diffusion Tensor MR Imaging Tractography of the Pyramidal Tracts Correlates with Clinical Motor Function in Children with Congenital Hemiparesis

“…These findings are similar to other studies that show that the cause of congenital hemiparesis is heterogeneous. [3][4][5]11,12 In particular, we observed different causes of hemiparesis within a severity group, as well as an overlap of causes between different groups. These included arterial infarcts in patients with moderate and severe hemiparesis, venous infarcts in patients with moderate and mild hemiparesis, and absence of any obvious cause in patients with moderate and mild hemiparesis.…”

“…1 Although imaging findings are well described, most studies have failed to show a statistically significant correlation between clinical severity of motor dysfunction and MR imaging findings. [2][3][4][5][6] Diffusion tensor MR imaging (DTI) tractography is a noninvasive method to segment specific white matter pathways, such as the pyramidal tracts. Using DTI, the motion of water can be quantified along 3 principal directions, where motion along the direction with the greatest water displacement is represented by the major eigenvalue ( 1 ), and motion along directions perpendicular to the major eigenvalue are represented by the minor eigenvalues ( 2 and 3 ).…”

An Algorithm for Identifying and Classifying Cerebral Palsy in Young Children

“…As a result, children with diparesis have brain lesions that are less likely to be located in white matter association areas that may impair cognition and they have lower rates of microcephaly. In contrast, hemiparesis, with arm more involved than leg, often reflects focal injury/middle cerebral artery distribution stroke-like events, more often sparing fibers closest to the ventricle that control legs ( [65], [66], [67]). Hemiparesis, which involves the leg comparably or more than the arm, is associated with periventricular hemorrhagic infarction [68].…”