Hemiplegic Cerebral Palsy: Correlation Between Ct Morphology and Clinical Findings

Abstract

SUMMARY Morphological findings on CT were compared with clinical features of 111 children with hemiplegic cerebral palsy. Periventricular atrophy, interpreted as periventricular leukomalacia, was the most prevalent CT finding, although this type of lesion did not indicate severity of neurological impairment. Maldevelopments were associated with arm‐dominated hemiplegia and with a wider range of clinical impairments than previously described. Cortical/subcortical atrophy, less common than presumed, indicated arm‐dominated hemiplegia and was associated with more severe impairment than were other CT findings. A normal CT scan indicated leg‐dominated hemiplegia and mild impairment. The morphological information obtained by CT was found to be useful for predicting clinical outcome, and was considered an important adjunct to clinical history and findings in these children. RÉSUMÉ I.M.C. à forme hémiplégique: corrélations entre la tnorphologie au scanner et les données cliniques Les données morphologiques de scanner ont été comparées avec les caracteristiques cliniques chez 111 enfants I.M.C. hémiplégiques. L'atrophie périventriculaire interprétée comme une leucomalacie périventriculaire, était la donnée de scanner la plus fréquente bien que ce type de lésion ne soit pas significatif de la gravité des troubles neurologiques. Les anomalies de développement étaient associées à une hémiplégie prédominant aux membres supérieurs et avec une plus grande étendue d'altération clinique qu'il n'a été décrit antérieurement. L'atrophie corticale/sous‐corticale, moins habituelle qu'il n'était pensé, indiquait une hémiplégie prédominant aux membres supérieurs associée à des altérations plus graves qu'avec les autres donnees de scanner. Un scanner normal indiquait une hémiplégie prédominant aux membres inférieurs et des atteintes modérees. L'information morphologique donnée par le scanner s'est révélée utile pour prédire le devenir clinique et fut considérée comme un complément important à I'histoire clinique et aux données d'examens chez ces enfants. ZUSAMMENFASSUNG Hemiplegische Cerebralparese: Korrelation zwischen CT Morphologie und klinischen Befunden Von 111 Kindern mit hemiplegischer Cerebralparese wurden die morphologischen Befunde im CT mit den klinischen Symptomen verglichen. Der häufigste CT Befund war eine periventrikuläre Atrophie, interpretiert als periventrikuläre Leukomalazie, obwohl diese Läsion nichts über den Schweregrad der neurologischen Ausfälle aussagte. Entwicklungsstörungen waren mit einer vorwiegend die obere Extremität betreffenden Hemiplegie und mit umfassenderen klinischen Störungen, als zuvor beschrieben, verbunden. Kortikal/subkortikale Atrophie, die seltener war als angenommen, deutete auf eine vorwiegend die obere Extremität betreffende Hemiplegie hin und war mit schwereren Behinderungen verbunden als andere CT Befunde. Ein normales CT wies auf eine hauptsächlich die untere Extremität betreffende Hemiplegie und leichte Behinderungen hin. Die morphologische Information durch das CT ist für die Prognose d...

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

“…The relative contribution of the different lesion groups was very similar to previous studies. [8][9][10]23,24 Also, no significant differences were found between included and excluded children with respect to demographic characteristics and functional use of the arm. Second, the cross-sectional nature of the study with the wide range in age is a limitation.…”

“…This is in e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 4 ( 2 0 1 0 ) 1 6 9 -1 7 7 accordance to several other studies. [8][9][10]23,24 Remarkably, a great number of children with periventricular damage also had basal ganglia/thalamic involvement. Recently, it has been recognized that deep gray matter volume, including thalamus and basal ganglia, is reduced among preterm born children at term-equivalent age, and that this is most prominent among children with periventricular leukomalacia or haemorrhagic infarction.…”

“…Better upper limb function among hemiplegic children with periventricular lesions was also reported by others. [7][8][9] However, in these studies the evaluation of hand function was limited to a simple grading of the severity using 3-to 4-point ordinal scales. Results in our study additionally showed that children in the PVL-group had more grip strength and a tendency for lower muscle tone compared to children in the ACQ-group.…”

“…8 Previous attempts have been made to relate the classified lesions to the severity of neurological impairment. [7][8][9][10][11] While some suggest that cortical-subcortical lesions result in a more severe hemiparesis or impaired upper limb function compared to periventricular lesions, [7][8][9] others could not demonstrate a relation between the different lesions types and upper limb function. 10,11 All studies included children with congenital hemiplegia and one study also included children with a postnatally acquired hemiplegia.…”

Diffusion Tensor MR Imaging Tractography of the Pyramidal Tracts Correlates with Clinical Motor Function in Children with Congenital 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 ).…”