Magnetic Resonance Imaging Findings in Patients with Cerebral Palsy

Yıl 2009, Cilt: 11 Sayı: 3, 16 - 20, 01.12.2009

Nuri Tasalı Rahmi Çubuk Kemal Şahin Mümtaz Özarar Ayşegül Çubuk Bülent Saydam Saydam Abdulkadir Koçer

Öz

Aim: The aim of this study was to identify the frequency of lesions demonstrating hypoxic-ischemic cerebral damage and to delineate the timing of the injury through cranial magnetic resonance imaging (MR) examination in cases that are followed up with the diagnosis of cerebral palsy (CP). Material and Methods: Cranial MR examinations of 23 CP cases between the ages of 2-33 years, with unknown birth histories were included in the study.Results: In 17 cases (74%) MRI findings of hypoxic ischemic cerebral injury were defined. Findings of hypoxicischemic brain injury were periventricular leukomalacia in 9 cases (%39), parasagital damage in 5 cases (%21), cerebral malformation in 2 cases (%9) and basal ganglion pathology in 1 case (%5). In 3 cases (13%) there were no sign of neural parenchymal pathology, The remaining three cases (13%) had findings such as cerebellary vermian hypoplasia (2 cases) and cerebral and cerebellar athrophy (1 case);.which can not be encountered as diagnostic findings of hypoxic ischemic injury . In one of the cases of spastic CP there were no sign of neural parenchymal pathology whereas in 8 cases periventricular leukomalacia, in 4 cases parasagittal damage and in 1 cases hydrancephaly and in another case cerebral and cerebellar athrophy were detected. In two cases who had extrapyramidal (atetoid ) CP; basal ganglion pathology and parasagittal damage were identified in different cases. In cases with mixed type CP there were no sign of neural parancyhmal pathology whereas in two of them periventricular leukomalacia and in 1 cases schizencephaly associated with non-lissencephalic cotical dysplasi were observed Conclusion: We did not find specific magnetic resonance imaging findings in accordance with the clinical types of the cerebral palsy. In cerebral palsy most of the ischemic damage occurs during the prenatal period especially in the third trimester while perinatal events less commonly cause such injuries. These findings indicate that MRI should be a part of the routine clinical investigation in cerebral palsy cases

Anahtar Kelimeler

Magnetic resonance imaging, cerebral palsy, prenatal

Serebral Palsi’li Olgularda Kranyal Manyetik Rezonans Görüntüleme Bulguları

Öz

Amaç: Serebral palsi (SP) tanısıyla takip edilen olguların kranyal manyetik rezonans incelemelerinde, hipoksikiskemik beyin hasarını gösteren lezyonların sıklığı ve oluşmuş olan hasarın zamanlamasının saptanmasıdır.Materyal ve Metot: Yaşları 2 ile 33 arasında değişen toplam 23 serebral palsi’li olgunun kranyal manyetik rezonans incelemeleri çalışmaya dahil edildi. Bulgular: On yedi olguda hipoksik-iskemik beyin hasarını gösteren bulgular saptandı. Hipoksik-iskemik beyin hasarını gösteren bulgular sırasıyla; 9 olguda periventriküler lökomalazi (%39), 5 olguda parasagital hasar (%21), 1 olguda bazal gangliyon tutulumu (%5) ve 2 olguda serebral malformasyon (%9) olarak izlendi. Üç olguda nöral parankimal patoloji izlenmedi. Kalan üç olguda hipoksik-iskemik beyin hasarı için tanı koydurucu olmayan serebellar vermis hipoplazisi (2 olgu) ve serebral/serebellar atrofi (1 olgu) saptandı. Spastik SP’li olguların birinde nöral parankimal patoloji saptanmazken, 8 olguda periventriküler lökomalazi, 4 olguda parasagittal hasar, 1 olguda hidranensefali ve 1 olguda serebral/serebellar atrofi saptandı. Ekstrapiramidal (atetoid) SP’li 1 olguda bazal gangliyon tutulumu, 1 olguda da parasagittal hasar saptandı. Mikst tip SP’li olguların ikisinde nöral parankimal patoloji saptanmazken, 1 olguda periventriküler lökomalazi, 1 olguda da non-lizensefalik kortikal displazinin eşlik ettiği şizensefali izlendi. Sonuç: Serebral palsinin klinik tiplerine özgü spesifik manyetik rezonans görüntüleme bulguları saptanmadı. Serebral palside iskemik hasar çok büyük oranda prenatal dönemde ve özellikle üçüncü trimesterde gerçekleşmekte olup, perinatal olaylar daha az oranda sorumludur. Manyetik rezonans görüntüleme serebral palsili olgularda rutin klinik ve laboratuvar değerlendirmede mutlaka bulunması gereken bir tanı yöntemidir

Anahtar Kelimeler

Manyetik rezonans görüntüleme, serebral palsi, prenatal

Kaynakça

• Swaiman KF: Cerebral Palsy. In Swaiman KF, Ashwal S (eds): Pediatric Neurology. Third ed. St Louis. Mosby. pp: 312-324, 1999.
• Behrman RE: Nelson Textbook of Pediatrics Pocket Companion. First ed. Philadelphia. W.B. Saunders Company. pp: 412-13, 1993.
• Blair E, Stanley FJ: Intrapartum asphyxia: A rare cause of cerebral palsy. J Pediatr. 112:515-519, 1988.
• Nelson KB: What proportion of cerebral palsy is related to birth asphyxia?. J Pediatr. 112:572-573, 1988.
• Truwit CL, Barkovich AJ, Koch TK, Ferriero DM: Cerebral Palsy: MR Findings in 40 Patients. AJNR. 13:67-78, 1992.
• Barkovich AJ: Pediatric Neuroimaging. Third ed. Philadelphia. Lippincott-Raven. pp: 157-282, 2000.
• Hill A, Volpe JJ: Hypoxic-ischemic Cerebral Injury in the Newborn. In Swaiman KF, Ashwal S (eds): Pediatric Neurology. Third ed. St Louis: Mosby. pp:191-204, 1999
• Yin R, Reddihough D, Ditchfield M, Collins K: Magnetic resonance imaging findings in cerebral palsy. J.Paediatr. Child Health. 36:139-44, 2000.
• Campistol J, Poo P, Alvarez EF: Parasagittal Resonance Findings. J Child Neurol. 14:683- 685, 1999.
• Ball WS. Neonatal Brain Injury: In Ball WS (ed): Pediatric Neuroradiology. First ed. Philadelphia. Lippincott-Raven. pp: 239-272, 1997.
• Hayakawa K, Kanda T, Hashimoto K, Okuno Y, Yamori Y: MR of Spastic Tetraplegia. AJNR. 18:247-253, 1997.
• Okumura A, Hayakawa F, Kato T, Kuno K, Watanabe K: MRI findings in patients with spastic cerebral palsy. I: correlation with gestational age at birth. Dev Med Child Neurol. 39:363-368, 1997.
• Yokochi K, Aiba K, Kodama M, Fujimoto S: Magnetic resonance imaging in athetotic cerebral palsied children. Acta Paediatr Scand 80:818-823, 1991.
• Flodmark O: Brain imaging studies of individulas with cerebral palsy. In Rivista di Neuroradiologia. pp: 183-184, 2003. Magnetic