Magnetic resonance imaging, risk factors and co-morbidities in children with cerebral palsy

Cerebral palsy (CP) continues to be a major problem in India. The present study provides an insight into the various clinical and neuroradiological correlates of CP. The study included 102 children with CP and was subjected to magnetic resonance imaging (MRI) of the brain. Forty-seven (46%) patients belonged to the 1–3 years age group and 84 (82%) were born at term. Of 102 children, 39 (38%) were delivered at home. Based on their tone and topographic pattern of weakness, it was found that 47 (46%) had spastic diplegia and 35 (34%) spastic quadriplegia. Hemiplegic, dystonic, and atonic CP accounted for the remaining 20%. The occurrence of severe birth asphyxia, which is rarely seen in developed countries, continues to be a major problem in developing countries, and accounted 64 (62%) of the patients. Cognitive delay (82%) was the most common co-morbidity, followed by seizure disorder (52%), feeding difficulties (22%) and visual abnormalities (29%). Ninety-one (89%) children had an abnormal MRI. Periventricular white matter injury (PWMI) was observed in 48 (47.1%), followed by diffuse encephalopathy (29%). Focal lesions (6%) and malformations (3%) were less common. In children with spastic diplegia, PWMI was the most common MRI abnormality, whereas in spastic quadriplegia, diffuse encephalopathy was most common. MRI scans help in revealing the pathologic basis of CP and had strong correlations with clinical findings.