Paediatria Croatica, Vol. 57 No. 2, 2013.
Sažetak sa skupa
TIMING OF BRAIN LESIONS IN CHILDREN WITH CEREBRAL PALSY
Ingeborg Krageloh-Mann
; University Children‘s Hospital, Department of Pediatric and Developmental Neurology, Tübingen, Germany
Sažetak
Neuroimaging is often abnormal in children with cerebral palsy and it helps understand the etiology or at least the pathogenesis, and thus timing of the underlying brain disorder. It may also help understand the structure-function relationship. Cerebral palsy is due to a non-progressive interference/lesion/abnormality in the developing brain (part of cerebral palsy definition). Pathogenic events affecting the developing brain cause lesions/maldevelopments, the patterns of which depend on the stage of brain development. Magnetic resonance imaging has the potential to visualize and further specify or identify lesions or maldevelopments of the brain. A systematic review of studies using magnetic resonance imaging in children with cerebral palsy, according to pathogenetic patterns characterizing different timing periods and with respect to gestational age (term versus preterm born) as well as in cerebral palsy subtypes shows abnormal magnetic resonance imaging in 86% of cases, giving clues to pathogenesis in 83% of cases. Periventricular white matter lesions were the most common pattern reported, altogether in around 60% of children with cerebral palsy (excluding ataxic cerebral palsy). It was by far the predominant magnetic resonance imaging finding in preterm cerebral palsy (around 90%). Periventricular leukomalacia and/or consequences of intraventricular hemorrhage of different topography and extent easily explain the cerebral palsy subtypes reported, e.g., spastic cerebral palsy, either bilateral and leg-dominated (diplegia) or unilateral. The fact that preterm cerebral palsy has in the vast majority an injury pattern that corresponds to the period of birth of these children does not tell us when exactly – shortly before, during or after birth – the injury has been acquired. This is the scope for other studies, e.g., matched control studies involving pre-, peri- and neonatal risk factors. Data on cerebral palsy prevalence could give indirect evidence as changes in the prevalence in preterm cerebral palsy reflects to 90% change in the prevalence of this injury pattern. In term born children with cerebral palsy, periventricular white matter lesions were reported in around 20%, again mainly in milder BS- cerebral palsy forms (diplegia); then mostly a periventricular leukomalacia pattern, but also in US- cerebral palsy, here either focal periventricular gliosis rather than asymmetric periventricular leukomalacia or unilateral porencephalic ventricular enlargement (suggesting IVH sequels). A prenatal origin in the term born children with cerebral palsy showing this injury can be assumed, which is supported by the fact that these children usually have an unremarkable peri- and neonatal history. Cortical or deep grey matter lesions represent the second most frequent pattern in cerebral palsy with a little less than 20% (excluding ataxic cerebral palsy). They were the typical lesions of term born children with athetoid cerebral palsy or severe BS- cerebral palsy (‘tetraplegia’ or ‘quadriplegia’), reported in 44% of cases. Basal ganglia/thalamus or bilateral cortico-subcortical lesions in these children suggest a peri/neonatal origin, as these patterns are highly associated to peri- and neonatal compromise. It has to be emphasized, however, that this conclusion cannot be drawn without a clear peri- and neonatal history supporting this assumption, ideally with sequential imaging (e.g., US) to document brain edema or an evolving lesion. In the case of an uneventful peri- and neonatal period, a prenatal origin has to be assumed. In US- cerebral palsy, cortical or deep grey matter lesions occurring in around one-third of cases were mainly infarcts, their precise timing is even more difficult; convulsions during the neonatal period may indicate a neonatal origin. When cortical or deep grey matter lesions were reported in former preterm born children with cerebral palsy, they tended to be of higher gestational age. Brain maldevelopments indicating 1st and 2nd trimester origin were rather rare, reported in less than 10% of children with cerebral palsy. They occurred six times more often in term born children with cerebral palsy than in preterm. The cerebral palsy subtype with a somewhat higher proportion of these patterns was US- cerebral palsy (spastic hemiplegia), where cortical dysplasias, unilateral schizencephaly and other focal malformations accounted for 16% of cases, and also ataxic cerebral palsy where 17% of cases were reported to have cerebellar hypoplasias. In conclusion, cerebral palsy is mainly characterized by brain lesions which can be identified by magnetic resonance imaging in around 75%, while maldevelopments occur in around 10% of cases.
Ključne riječi
Hrčak ID:
105053
URI
Datum izdavanja:
25.6.2013.
Posjeta: 346 *