Due to a defect or lesion of the immature brain, the term cerebral palsy (CP) describes a group of disorders of movement and posture (1), with various types and degrees of motor impairment and is the commonest physical disability in childhood. In many cases the cause remains unknown. The definition is usually based on phenomenology; it only specifies that CP originates from an interference, lesion, or abnormality of the developing brain (2). CP may cause a range of associated problems including; hearing and visual deficits, nutritional and feeding problems, respiratory infections, epilepsy, pain, cognitive and communicative impairments in children. Due to prenatal or perinatal brain damage, CP is a permanent and non-progressive disorder become manifest early in life. Congenital hemiplegia is the most common form of cerebral palsy among children born at term, and second to diplegia among children born prematurely (3). The cerebral palsy that affecting approximately 3 in 1000 newborns, has not diminished in recent decades despite advances in obstetric and neonatal care . In fact, in the world, the risk of CP among term infants may have increased between the years 1975 and 1991, from 1.7 to 2.0 per 1000 live births. Approximately 8000 children with CP, based on these numbers, are born annually in the United States and approximately 10 to15% of very preterm children (born < 30 weeks gestational age) develop cerebral palsy, and 30 to 60% of them experience cognitive impairments (4). The decrease in perinatal mortality in very and extremely pre-term infants has led to an increasing prevalence of cerebral palsy (5).

With the technical progress made in fetal and neonatal intensive care, perinatal mortality has decreased by 25% over the past decade mainly because of the improvements in ventilatory management(6). Rates of prematurity, however, have increased during the same time period, leading to a higher number of high-risk newborns that suffer from considerable neurological morbidity, often associated with cerebral palsy. Furthermore, in clinical negligence claims, it is now widely acknowledged that most cerebral palsy is not the result of intrapartum hypoxia.2, Lesions responsible for periventricular leukomalacia and posthemorrhagic porencephaly are considered to occur early in the third trimester. Both vascular and intrinsic metabolic factors are thought to be responsible for the localization of periventricular leukomalacia. In patients with spastic tetraplegia, congenital abnormalities are often found in magnetic resonance imaging (MRI)(7).

We prospectively evaluated children with cerebral palsy referred to our Paediatric Department for 01 Year. The present study included 140 children (80 males and 60 females; mean age, 8.25±4.50 years) with spastic tetraplegia, diplegia, and hemiplegia cerebral palsy. In each case of cerebral palsy, the diagnosis was confirmed. Children with postnatal meningitis, encephalitis, trauma, and metabolic or degenerative disorders were excluded from the study.

The patterns of Magnetic Resonance Imaging (MRI) MRI, which often used for reveals anatomic abnormalities, could offer a unique, non-invasive opportunity to predict neurological deficits, even as early as the newborn stage.

Births with unknown gestational age, postnatally acquired CP cases and cases with secondary causes like metabolic and genetic were excluded from the study. MRI findings were classified into 7 categories, WMI, superficial Gray matter injury, deep Gray matter injury, focal vascular insults, intracranial haemorrhage, cerebral malformations, and normal findings.

Table No. 1: Age Distribution

The chi-square statistic is 43.6617. The p-value is .00701. The result is significant at p < .05.

Table No. 2: Gestational age

The chi-square statistic is 0.0048. The p-value is .944812. The result is not significant at p < .05.

Table No. 3: Type of CP distribution.

The chi-square statistic is 21.018. The p-value is .047261. The result is significant at p < .05.

Table No. 4: MRI findings among CP subjects.

We find maximum case in WM injury 51% followed by normal 27%. The chi-square statistic is 50.6833. The p-value is < 0.00001. The result is significant at p < .05.

We have demonstrated significant abnormalities on MRI in 95.3% of children with spastic cerebral palsy. Our results are comparable with the findings of earlier reports. The MRI findings were heterogen ous in the spastic tetraplegic and hemiplegic cerebral palsy children. Patients with spastic diplegia constituted a rather homogenous group(8). Pretermtype brain injury, especially periventricular leukomalacia, dominated in this group. Other MRI findings were rare in this group. These results are in agreement with those of other authors who have reported that periventricular leukomalacia is the main lesion in patients with spastic diplegia. Periventricular leukomalacia is a form of hypoxic-ischemic damage typical of the immature brain and most commonly seen as a complication of preterm birth. As this lesion was found in children born at term, it was considered to reflect a cerebral injury that had occurred in utero. In the present report, the most common finding on MRI was periventricular leukomalacia(9). Moreover similar proportions of periventricular leukomalacia were detected in the tetraplegic and the hemiplegic cerebral palsy groups.

However, periventricular leukomalacia was observed more frequently in patients with spastic diplegia. It is important to note that almost half the cerebral palsy children with periventricular leukomalacia were born at term with no history suggestive of perinatal asphyxia or low birth weight. Ventricular enlargement is common in preterm and low-birth-weight infants(10). In our study, ventricular enlargement was more often observed in children with spastic tetraplegia and preterm subjects who as babies had experienced periventricular hemorrhage of grade 3 or 4. This is in accordance with previous reports.

Children with unilateral schizencephaly present with hemiparesis and mild mental delay.25 Patients with bilateral cleft are tetraparetic with severe mental deficits. In the present report, schizencephaly was found in 5 children with spastic cerebral palsy(11).

The distribution of cerebral abnormalities in our cohort was lower than that found in Towsley K et al., and Robinson MN et al., CP studies and similar to the Sharma N and Dhande R, study (71%). The frequency of preterm births in our study (34.9%) was similar to that of the Towsley K et al., (39%) and Robinson MN et al., (34%) studies, but differs with the Sharma N and Dhande R, (68.33%) and Aggarwal A et al., (22.2%) studies. There are variations between the classification schemes utilised for these studies, so it is difficult to determine if actual population variations exist(12-14).

According to the reviewed studies, most children with cerebral palsy have abnormal neuroradiological findings. MRI plays a significant and valuable role in revealing the pathologic basis of CP and had strong correlations with clinical findings in term- and preterm- born children. Also it has high potential to detect the type, extent, and possible time of brain damage in children with CP.

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