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MRI findings in patients with spastic cerebral palsy. I: Correlation with gestational age at birth
A Okumura1, F Hayakawa, T Kato
1Department of Pediatrics, Anjo Kosei Hospital, Aichi, Japan.
Insights
Brain MRI findings in children with spastic cerebral palsy (CP) correlate with gestational age. Preterm-born infants often show periventricular leukomalacia (PVL), while term-born infants exhibit different brain injuries.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Spastic cerebral palsy (CP) is a common childhood motor disability.
- Brain imaging is crucial for understanding CP's underlying causes.
- Gestational age at birth is a known risk factor for various neonatal complications.
Purpose of the Study:
- To investigate the relationship between gestational age at birth and specific brain MRI findings in children with spastic CP.
- To determine if preterm-type brain injuries are exclusive to preterm infants.
Main Methods:
- Retrospective analysis of brain MRI scans from 152 pediatric patients (1-19 years) with spastic CP.
- Correlation of MRI findings, including periventricular leukomalacia (PVL) and other brain lesions, with gestational age at birth.
- Categorization of brain injuries into preterm-type and term-type based on MRI characteristics.
Main Results:
- Periventricular leukomalacia (PVL) was observed in 90 patients, predominantly those born preterm (90%).
- Severe PVL was associated with gestational ages between 25 and 32 weeks.
- Term-type brain injuries, such as border-zone infarcts and basal ganglia-thalamic lesions, were exclusively seen in infants born at or near term.
- Preterm-type injuries were also noted in some term-born infants.
Conclusions:
- MRI findings in spastic cerebral palsy show a strong correlation with gestational age at birth.
- Gestational age is a significant determinant of the type and severity of brain injury observed in CP.
- Understanding these correlations aids in diagnosing and managing CP.
Abstract:
The authors studied MR images of the brain in 152 patients, aged 1 to 19 years (mean 3.3), who had spastic cerebral palsy (CP) and were attending two hospitals in Japan in 1993 and 1994. The relation was studied between the patients' gestational age at birth and their MRI findings, including the severity of periventricular leukomalacia (PVL) seen on MRI. In 119 of these patients, the CP was thought to be due to acquired, destructive brain injury. PVL was seen in 90 and posthemorrhagic porencephaly in 11. These preterm-type brain injuries were observed often in patients who had been born preterm but were also seen in those born at term. Fullterm-type border-zone infarct, bilateral basal ganglia-thalamic lesion, subcortical leukomalacia, and multicystic encephalomalacia were seen in 9, 14, 7, and 3 patients, respectively; these term-type brain injuries were observed only in patients born at or near term. Of the patients with PVL, 90% had been born preterm. Severe PVL was common in the patients whose gestational ages at birth were between 25 and 32 weeks; all patients with PVL who had been born at term had only mild PVL. The authors concluded that MRI findings for patients with spastic CP are closely correlated with gestational age.