BRAIN MAGNETIC-RESONANCE-IMAGING IN SUSPECTED EXTRAPYRAMIDAL CEREBRAL-PALSY - OBSERVATIONS IN DISTINGUISHING GENETIC-METABOLIC FROM ACQUIRED CAUSES

Experienced clinicians recognize that some children who appear to have static cerebral palsy (CP) actually have underlying genetic-metabolic disorders. We report a series of patients with motor disorders seen i n children with extrapyramidal CP in whom brain magnetic resonance ima ging abnormalities provided important diagnostic clues in distinguishi ng genetic-metabolic disorders from other causes. One cause of static extrapyramidal CP, hypoxic-ischemic encephalopathy at the end of a ter m gestation, produces a characteristic pattern of hyperintense signal and atrophy in the putamen and thalamus. Other signal abnormalities an d atrophy in the putamen, globus pallidus, or caudate can point to gen etic-metabolic diseases, including disorders of mitochondrial and orga nic acid metabolism. Progress in understanding and treating genetic di seases of the developing brain makes it essential to diagnose disorder s that masquerade as static CP. Brain magnetic resonance imaging is a useful diagnostic tool in the initial evaluation of children who appea r to have CP.