CONGENITAL HEMIPLEGIA - MORPHOLOGY OF CEREBRAL-LESIONS AND PATHOGENETIC ASPECTS FROM MRI

We have analyzed the MRI findings from the brains of 33 children with congenital hemiplegia. Referral of these children to our hospital was either because of neurological problems or a history of complicated bi rth. According to maturation-dependent pathophysiological mechanisms w e have classified the lesions into the following five groups: 1. malfo rmations/prenatal encephalo-clastic lesions, 2. periventricular leukom alacia or atrophy, 3. diencephalic lesions, 4. subcortical and cortica l lesions, and 5. normal findings. Combination of lesions was not unco mmon. The neuroradiologically most prominent and most expanded lesions determined the classification to the different groups. We detected ma lformations/encephalo-clastic lesions (Group 1) in 5 children; one of these children also presented additional lesions of Groups 2 and 3. Si x children displayed periventricular leukomalacia (Group 2), and in on e child in combination with diencephalic and subcortical lesions. Ten children exhibited diencephalic lesions (Group 3), in one case combine d with periventricular leukomalacia. The MRI of seven children showed subcortical/cortical lesions (Group 4), in four cases extending into d iencephalic structures. Two children had a combination of evenly match ed periventricular, diencephalic and subcortical/cortical lesions, whe re it was impossible to define a principal lesion. Three children had normal MRI findings. Significantly, 8 of 33 children had bilateral les ions although presenting with hemiplegia. The large proportion of dien cephalic lesions, not described in similar CT studies, and the small n umber of normal MRI findings show the value of MRI in evaluation of co ngenital hemiplegia. The ability to correlate, to some extent, neurora diological findings of damage to developmental stage affords the concl usion that at least a third of the children in our series with congeni tal hemiplegia suffered prenatal damage.