Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy

Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP.

Cerebral palsy in Jordan: clinical and neuroimaging characteristics

To evaluate the diagnostic findings of neuroimaging in patients with cerebral palsy and if there is any specific finding correlated to certain types of Cerebral Palsy. Case records of 158 patients diagnosed to have cerebral palsy attending the pediatric neurology and neurodevelopmental clinics at King Hussein Medical Center and King Abdullah University Hospital over 2 years period, 2006 and 2007, were studied retrospectively with reference to their clinical characteristics and their correlation to the neuroimaging [MRI and CT scan] findings. A total of 158 cases with cerebral palsy were included in the study, 84 [53%] males, 74 [47%] females, 41 [26%] preterm and 117 [74%] full- term babies. Spastic cerebral palsy was seen in 112[70.8%] with spastic quadriplegia being the commonest seen in 63[40%]. Hypotonic ataxic type present in 22[14%], dyskinetic 15[9.4%] and mixed cerebral palsy in 9[5.6%]. Abnormal neuroimaging findings were seen on MRI in 125[79%], while in CT scan in 113[71%]. Specific neuroimaging findings were seen suggesting brain asphyxia in 40[25%], congenital brain anomaly in 22[14%], intracranial hemorrhage in 10[6%], vascular and infectious causes in 29[18.5%], unknown/Isolated brain atrophy in 26[16.5%], and periventricular leukomalacia in 31[20%]. The most common single etiology identified was birth asphyxia 40[25%], and the second is periventricular leukomalacia which was identified in 31 patients [20%]. Nonspecific brain atrophy was considered as nonspecific finding, that was found most often in patients with dyskinetic CP 5/15[33%], and in patients with spastic quadriplegia 15/63[24%] as compared to other groups. The principle contribution of imaging is to the understanding of etiology and pathogenesis, including ruling in or out conditions that may have implicated a genetic counseling, such as malformations. MRI is a more sensitive test than CT in detecting brain abnormalities

Correlation of brain CT findings and developmental outcome in patients with spastic cerebral palsy

Brain computed tomography (CT) is a useful tool for evaluating the pathologic findings in the brains of children with neurologic abnormalities. Brain CT investigation and the Munchner Funtionelle Entwicklungs Diagnostik (MFED) developmental assessment was performed in 88 patients with spastic cerebral palsy. The incidence of abnormal brain CT findings in patients with spastic cerebral palsy was 69.3%. The group with pathologic CT findings had a greater possibility of having developmental delay than the group with normal CT findings (p < 0.05). However, there was no significant relationship between the specific MFED categories and the types of brain CT abnormalities. Pathological CT findings could offer important prognostic information indicating a higher risk concerning the grade of developmental delay.