van der Knaap M S, Smit L S, Nauta J J, Lafeber H N, Valk J
Department of Child Neurology, Free University Hospital, Amsterdam, The Netherlands.
Neuropediatrics. 1993 Jun;24(3):143-8. doi: 10.1055/s-2008-1071532.
Cortical laminar necrosis is a histopathological entity, related to conditions of cerebral energy depletion. Clinical correlates are supposed to be spastic motor deficits, decreased intellectual capacity and epilepsy. A study was performed in 45 children with cortical laminar abnormalities in signal intensity on MRI. The purpose of the study was to evaluate causes and clinical consequences of these cortical abnormalities on MRI in order to find indirect evidence for the hypothesis that they may represent cortical laminar necrosis. In view of the frequently present concomitant white matter damage, two contrast groups were formed: one group of 40 children with periventricular white matter abnormalities, part of them with subcortical extensions of the white matter damage; and another group of 53 children without abnormalities on MRI. Data concerning history, present clinical condition and final diagnosis were collected. The presence of cortical laminar abnormalities on MRI was found to be strongly associated with a history of cerebral energy depletion, especially hypoxia-ischemia, either in the perinatal period or later in life. Whereas white matter abnormalities tended to be more frequent in premature children, cortical laminar abnormalities tended to occur more frequently in term neonates and older children. The presence of cortical laminar abnormalities on MRI was correlated with an increased risk of spasticity in children without concomitant white matter abnormalities. In children with white matter lesions, cortical laminar abnormalities did not contribute to the risk of spasticity, which was already highly increased by the presence of white matter damage. No association was found between cortical abnormalities on MRI and epilepsy or psychomotor retardation.(ABSTRACT TRUNCATED AT 250 WORDS)
皮质层状坏死是一种组织病理学实体，与脑能量耗竭状况相关。其临床相关表现被认为是痉挛性运动障碍、智力减退和癫痫。对45例MRI信号强度显示皮质层状异常的儿童进行了一项研究。该研究的目的是评估这些MRI上皮质异常的病因及临床后果，以便为它们可能代表皮质层状坏死这一假说找到间接证据。鉴于常伴有白质损害，形成了两个对照小组：一组40例脑室周围白质异常的儿童，其中部分有白质损害的皮质下扩展；另一组53例MRI无异常的儿童。收集了有关病史、当前临床状况及最终诊断的数据。发现MRI上皮质层状异常与脑能量耗竭病史密切相关，尤其是围生期或生命后期的缺氧缺血。白质异常在早产儿中往往更常见，而皮质层状异常在足月儿和大龄儿童中往往更频繁出现。MRI上皮质层状异常的存在与无伴发白质异常儿童的痉挛风险增加相关。在有白质病变的儿童中，皮质层状异常并未增加痉挛风险，白质损害的存在已使其痉挛风险大幅增加。未发现MRI上的皮质异常与癫痫或精神运动发育迟缓之间存在关联。（摘要截选于250词）
