HETEROGENEITY OF NEUROLOGICAL SYNDROMES IN SURVIVORS OF GRADE-3 AND GRADE-4 PERIVENTRICULAR HEMORRHAGE

To evaluate the topographical neurological distribution, patterns of a bnormal tone and related functional neuromotor impairment after grade 3 and grade 4 intraventricular/periventricular haemorrhage (IPVH), 33 children with previous grade 3 or 4 IPVH of mean gestational age 30.9 weeks (range 25-40 weeks) and mean birth weight 1743 g (range 866-3600 g) were examined neurologically at 4.7 years (range 0.75-10.8 years). Neurological signs were absent in 10/33 cases which were equally dist ributed between the grade 3 and grade 4 IPVH groups. The largest singl e topographical neurological distribution was hemiparesis in 8/23, fol lowed jointly by diplegia (cerebral paraplegia) in 6/23 and triplegia in 6/23 cases and finally quadriplegia in 3/23 cases. Grade 4 IPVH ten ded to result in asymmetrical syndromes, accounting for 7/8 cases of h emiparesis and 5/6 cases of triplegia, whereas all 3/3 cases of quadri plegia followed grade 3 IPVH. The 6/23 cases of diplegia were shared b etween the grade 3 and grade 4 IPVH groups. Tone was normal in 7/8 of the hemiparetic subjects. Dystonia was the commonest tone abnormality, affecting 8/23 children with neurological disturbance, followed by at axia/hypotonia in 4/23 and mixed dystonia/hypotonia in 3/23. Only 1/23 cases had signs of spasticity. Spasticity is rare following severe IP VH. Diplegic children had a better functional neuromotor grade than he miparetic children, who in turn did better than triplegic children. At axia hypotonia resulted in better functional outcome than dystronia, w hich in turn was more favourable than mixed tone patterns. Cranial ima ging by ultrasound (US) or computed tomographic (CT) scanning proved a n unreliable prognostic indicator except in the case of hemiparesis, f or which US scans correctly predicted the affected side in 5/7 cases. The neurological syndromes following severe IPVH differ from the class ical encephalopathy of prematurity, and this should lead to a re-appra isal of the trends in the prevalence of cerebral palsy. Caution should be exercised in the interpretation of cranial imaging with regard to pessimistic prognoses in the presence of changes or undue optimism in their absence.