Serebral palsili çocuklarda hipoksik iskemik ensefalopatide izlenen hasar formlarının manyetik rezonans görüntüleme ile araştırılması

Abstract

SUMMARY There are various patterns of CNS injury associated with hypoxic ischemic encephalopathy. However, their definition is based on neuropathological grounds, and the correlates on MR imaging are not extensively studied. MR findings in 38 cases of cerebral palsy were retrospectively searched for the presence of the hypoxic ischemic injury forms. Most of them were parasagittal cerebral injury (26.3 %), followed by thalamus and basal ganglia lesions (15.7 %), and major destructive events like multicystic encephalomalacia and hydranencephaly (10.5 %). The high incidence of full-term type parasagittal injury may be an indicator of inadequate perinatal services in Turkey. In this study we concentrated on the myelination and corpus callosum abnormalities associated with the various injury forms. Secondary destructive processes affecting the corpus callosum were observed in 47.3% of cases. Parasagittal cerebral injury was the most common of all (50 %), followed by major destructive events (22.2 %). Callosal body + the splenium were the most common involvement in126 parasagittal injury, whereas it's diffusely atrophied in major destructive events. Delay in myelination was detected in 10.5 % of cases, most of them associated with severe destruction of cerebral white matter as in multicystic encephalomalacia. 15.7 % of the cases had lesions which were defined to have a definite prenatal onset. This finding, together with the others, give new insights about the pathogenesis and the timing of asphyxia, which doesn't have a world wide accepted definition and criteria.

SUMMARY There are various patterns of CNS injury associated with hypoxic ischemic encephalopathy. However, their definition is based on neuropathological grounds, and the correlates on MR imaging are not extensively studied. MR findings in 38 cases of cerebral palsy were retrospectively searched for the presence of the hypoxic ischemic injury forms. Most of them were parasagittal cerebral injury (26.3 %), followed by thalamus and basal ganglia lesions (15.7 %), and major destructive events like multicystic encephalomalacia and hydranencephaly (10.5 %). The high incidence of full-term type parasagittal injury may be an indicator of inadequate perinatal services in Turkey. In this study we concentrated on the myelination and corpus callosum abnormalities associated with the various injury forms. Secondary destructive processes affecting the corpus callosum were observed in 47.3% of cases. Parasagittal cerebral injury was the most common of all (50 %), followed by major destructive events (22.2 %). Callosal body + the splenium were the most common involvement in126 parasagittal injury, whereas it's diffusely atrophied in major destructive events. Delay in myelination was detected in 10.5 % of cases, most of them associated with severe destruction of cerebral white matter as in multicystic encephalomalacia. 15.7 % of the cases had lesions which were defined to have a definite prenatal onset. This finding, together with the others, give new insights about the pathogenesis and the timing of asphyxia, which doesn't have a world wide accepted definition and criteria.