PREDICTION OF OUTCOME IN CHILDREN WITH CONGENITAL HEMIPLEGIA - A MAGNETIC-RESONANCE-IMAGING STUDY

The degree of Wallerian degeneration (WD) in the corticospinal tracts seen with magnetic resonance imaging (MRI) was correlated with the dis tribution and severity of congenital hemiplegia in 20 children aged ni ne months to nine years. All the children had hemispheric lesions diag nosed with ultrasound in the neonatal period: MRI and clinical assessm ent were performed from nine months to nine years of age. Hemiplegia w as graded as mild, moderate or severe and into predominantly upper or lower limb distribution. WD was assessed by the presence or absence of signal intensity changes in the internal capsule on inversion recover y and spin echo sequences and by the asymmetry of the upper brainstem. The degree of asymmetry was estimated by measuring the cross sectiona l area (CSA) of the brainstem at three levels and calculating the rati o of the measurements between the side of the lesion and the unaffecte d side. Infarct size was estimated from the CSA of the infarct at the maximum site of the lesion. Both measurements were correlated with the severity of outcome and the site of involvement. There was a better c orrelation between severity of outcome and brainstem asymmetry (p = 0. 003) than severity of outcome and infarct size (p = 0.02). There was a lso a significant correlation between upper limb involvement and brain stem asymmetry (p = 0.01). As WD estimated by brainstem asymmetry appe ars early and is easy to measure, it may be a good marker to estimate later impairment in infants with predominantly unilateral hemispheric haemorrhagic/ischaemic lesions diagnosed in the neonatal period.