ETIOLOGY, TIMING OF INSULT, AND NEUROPATHOLOGY OF CEREBRAL-PALSY EVALUATED WITH MAGNETIC-RESONANCE-IMAGING

To define the patterns of pathologic changes in cerebral palsy; (CP) a nd to assess the etiology and time of brain damage, we reviewed the ma gnetic resonance images and clinical records of 86 pediatric CP patien ts seen over 8 years. Patients were divided into two groups, based on the gestational age at birth. The majority of CP patients (69) had spa sticity. In the premature group (< 37 wk gestational age) (n = 27), sp astic diplegia (12 patients) and quadriplegia (8) were the major subty pes. In the term group (greater than or equal to 37 wk gestational age ) (n = 59), spastic hemiplegia (23) and quadriplegia (12) were most co mmon. The other main clinical manifestations in the two groups were se izures (36) and mental retardation (15). Magnetic resonance (MR) imagi ng provided significant findings in 82 patients (95%). In the 27 patie nts born prematurely, MR imaging revealed periventricular leukomalacia (17), multicystic encephalomalacia (3), cortical and subcortical atro phy (4), migration disorders (2), and basal ganglia injury (1). Among the patients born at term, the MR imaging findings were more heterogen eous; they included cortical and subcortical atrophy (17), brain malfo rmations (17), periventricular leukomalacia (6), multicystic encephalo malacia (5), porencephaly (4), hemiatrophy (3), delayed myelination (3 ), and none (4). MR imaging alone could define the time of brain insul ts in 73 of our 86 CP patients. Combined with clinical histories, MR i maging could help assess the time of insult in 93% of patients. The br ain insults occurred prenatally in 34 of our patients, perinatally in 37, and postnatally in eight. The time of insult could not be determin ed in six patients. In the premature patients, the insult occurred mos t frequently perinatally (74%), whereas in the term group it occurred most frequently prenatally (54%). MR imaging was found to be very help ful in the evaluation of the various neuropathologic changes in CP, in the depiction of the etiology, and in the determination of the time o f brain injury.