Ali Asuman, Yalçın Ramazan, Ünlüer-Gümüştaş Ayşem
Department of Neurology, Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Department of Radiology, Bursa State Hospital, Bursa, Turkey.
Turk J Pediatr. 2019;61(4):525-537. doi: 10.24953/turkjped.2019.04.009.
Ali A, Yalçın R, Ünlüer-Gümüştaş A. Cranial MR characteristics of Cerebral Palsy cases and correlation of findings with clinical results. Turk J Pediatr 2019; 61: 525-537. The aim of this study was to compare cranial Magnetic Resonance (MR) imaging findings in cerebral palsy (CP) patients with clinical findings and evaluate damage ascribed to prenatal, natal and postnatal reasons by preterm, term or postterm characteristics. One thousand, one hundred CP patients registered at Dr. Ayten Bozkaya State Hospital of Cerebral Palsy Children and Rehabilitation Center from 2007 to 2010 were included in the study retrospectively. Cranial MR images studied in Bursa State Hospital Radiology Unit were evaluated by a single senior MRI radiologist. The most common abnormality was cerebral atrophy (80.2%) followed by periventricular leukomalacia (PVL) (49.9%). The most common type was spastic tetraplegia (67.9%), and the second most common type was hypotonic CP (15.6%). The percentage of congenital central nervous system (CNS) abnormality was 14.09%. The most common abnormality was corpus callosum (CC) agenesis and colpocephaly (2.3%). The least common conditions were cortical dysplasia, heterotopia and rhombencephalosynapsis. The percentage of cases born to consanguineous parents was 19.2%. In Hypoxic Ischemic Encephalopathy (HIE) patients born to consanguineous parents, PVL was cystic and moderate. Consanguineous marriage was statistically significant in the patients with cortical dysplasia and heterotopia (p < 0.04), delay in myelination (p < 0.001) and thalamus involvement (p < 0.008). Consanguineous marriage was also statistically significant in spastic diparetic (p < 0.017), hypotonic (p < 0.001) and bedridden patients (p < 0.006). The presence of both congenital CNS anomaly and PVL was only revealed in spastic tetraparetic type. Twentynine% of the cases were premature, while 66.4% were term children. Low birth weight (32.7%) constituted a risk factor for all clinical types, except mixed type CP. The percentage of patients with natal causes only was 21.5%. Kernicterus, cerebrovascular causes and HIE accounted for 6.3%, 2.9% and 54.4% of the cases, respectively. This study may indicate the importance of consanguineous marriage, natal and postnatal care properties as the underlying causes of CP beyond the clinical management related to delivery and allow us to identify strategies for possible measures.
阿里·A、亚尔琴·R、于恩吕埃尔-居穆什塔什·A。脑瘫病例的头颅磁共振成像特征及检查结果与临床结果的相关性。《土耳其儿科学杂志》2019年；61:525 - 537。本研究的目的是比较脑瘫（CP）患者的头颅磁共振（MR）成像检查结果与临床表现，并根据早产、足月或过期产特征评估产前、产时和产后原因所致的损伤。回顾性纳入了2007年至2010年在艾顿·博兹卡亚国立脑瘫儿童及康复中心登记的1100例CP患者。在布尔萨州立医院放射科对头颅MR图像进行评估的是“一名资深MRI放射科医生”。最常见的异常是脑萎缩（80.2%），其次是脑室周围白质软化（PVL）（49.9%）。最常见的类型是痉挛性四肢瘫（67.9%），第二常见的类型是低张力型CP（15.6%）。先天性中枢神经系统（CNS）异常的比例为14.09%。最常见的异常是胼胝体（CC）发育不全和脑室扩张（2.3%）。最不常见的情况是皮质发育异常、异位和菱脑融合。近亲结婚生育的病例比例为19.2%。在近亲结婚生育的缺氧缺血性脑病（HIE）患者中，PVL呈囊性且程度中等。近亲结婚在皮质发育异常和异位患者（p < 0.04）、髓鞘形成延迟（p < 0.001）和丘脑受累患者（p < 0.008）中具有统计学意义。近亲结婚在痉挛性双侧瘫（p < 0.017）、低张力型（p < 0.001）和卧床患者（p < 0.006）中也具有统计学意义。先天性CNS异常和PVL同时存在仅在痉挛性四肢瘫型中发现。29%的病例为早产儿，而66.4%为足月儿。低出生体重（32.7%）是除混合型CP外所有临床类型的危险因素。仅由产时原因导致的患者比例为21.5%。核黄疸、脑血管病因和HIE分别占病例的6.3%、2.9%和54.4%。本研究可能表明近亲结婚、产时和产后护理特性作为CP潜在病因的重要性，其重要性超出了与分娩相关的临床管理范畴，并使我们能够确定可能采取措施的策略。
