MRI findings in patients with hemiparetic cerebral palsy

Given the more severe and extensive unilateral brain abnormalities in hemiparetic cerebral palsy (HCP) patients than in other spastic cerebral palsy patients we focused exclusively on the localization of brain lesions in children with HCP. The relationship between neuroradiological findings and side of hemiparesis was investigated in a group of 30 children with HCP. Seventeen boys and 13 girls aged four to18 years (mean age 9.7±4.2 years) were included in this study. Computed tomography and magnetic resonance imaging examinations were correlated with the birth histories, obstetrical records and clinical summaries. Of the 30 patients with HCP, 2 (6.6%) had normal neuroradiological examinations, 20 (66.6%) had unilateral and eight (26.6%) bilateral brain lesions. A brain lesion on the contralateral side of hemiparesis was found in 93.3% of the neuroradiological examinations. The commonest neuroradiological findings in our study were periventricular leukomalacia (PVL, 80%), atrophy (70%) and porencephalic cyst (50%). There was a significant relationship between the symptomatic side and contralateral PVL, atrophy and porencephalic cyst (40%). PVL, atrophy and porencephalic cyst were significantly concomitant on the same side (46.6%). We demonstrated for the first time in the literature that PVL, atrophy and porencephaly are usually observed concomitantly and contralateral to the side of motor impairement in HCP patients.