Çocuk Nörolojisi Bilim Dalına 01.10.2003-01.10.2009 yılları arasında başvuran serebral palsili olguların klinik ve laboratuvar bulgularının değerlendirilmesi

Abstract

01.10.2003 ? 01.10.2009 yılları arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Nöroloji Bilim Dalı polikliğine başvuran; ortalama başvuru yaşı 27,3 ±26,1 ay ve 96 (%56,8)`sı erkek, 73 (%43,2)'ü kız çocuğu 169 SP'li olgunun klinik ve laboratuvar bulguları geriye dönük incelendi.Olguların 25 (%14,8)'i <6 aylık; 21 (%12,4)'i 6-12 aylık, 50 (%29,6)'si 12-24 aylık ve 73 (%43,2)'ü >24 aylık iken başvurmuştu. Olguların doğum ağırlığı 59 (%36,1) olguda <2500 g; 104 (%63,8) olguda 2500 - 4500 gr idi. 108 (%66,2) olgu term, 55 (%33,7)'i pretermdi. 99 (%58,6) olgu vajinal yolla, 70 (%40,4)'i sezeryan ile doğmuştu. Vajinal doğumların 17 (%10)'si evde gerçekleşmişti.Serebral palsi tiplerine göre ayrıldığında; 144 (%86) olgu, spastik tip; 13 (% 7,7) olgu diskinetik tip; 6 (% 3,6) olgu mikst tip ve 5 (%3) olgu ataksik-hipotonik tipti. Spastik tiplerin 65 (%38,5)'i kuadriparezik; 43 (%25,6)'ü diplejik; 35 (%20,7)'i hemiparezik ve 2 (%1,2)'si monoparezikti.Risk faktörlerinden en sık asfiksi 99 (%58,9) görüldü. Onu sıklık sırasına göre, düşük doğum ağırlığı 61 (%36,1); prematürite 55 (%32,5) ve 7 (%4,1) olguda menenjit ve 6 (% 3,6) olguda sepsis izledi. Hiperbilirubinemi 16 (%9,5), hidrosefali 5 (%3) ve genetik anomaliler 5 (%3), intrakranial hemoraji ve tromboz gibi vasküler prosesler 7 (%4,2), hipoglisemi 1 (%0,6) idi. Olguların 8'sinde (%4,7) herhangi bir risk faktörü saptanmadı. 38 (%22,5) Olgunun anne babasında akraba evliliği mevcuttu.Olguların görüntüleme bulgularına göre; 45 (%26,6)'inde ensefalomalazi, 9 (%5,3)'unda corpus callosum anomalisi; 5 (%3)'inde polimikrogri; 2'sinde (%1,2) holoprosensefali; 2`sinde (%1,2) porensefalik kist; 1'inde (%0,6) şizensefali; 1'inde (%0,6) koroid pleksus kisti; 1'inde (%0,6) Arnold-Chiari malformasyonu, 33 (%19,5)'ünde kortikal atrofi; 18 (%10,6)'inde bazal ganglia hiperintensitesi; 7 (%4,1)'sinde serebral infarkt ve 4 (%2,4)'ünde hidrosefali vardı. 15 (%8,9)'inde görüntüleme normaldi.Sonuç olarak, çalışma sonuçlarımız intrauterin gelişmenin önemli kriterlerinden olan gebelik yaşı ve doğum tartısının SP etyopatogenezi ve SP prognozunda önemli bir rol oynadığı iddiasını doğrular niteliktedir.

This is a retrospective study on the clinical and laboratory findings of 169 children of ages between 2 mo.-13 years (mean 27.3±26,1 mo.) with cerebral palsy, of whom 96 (%56,8) were males and 73 (%43.,2) were girls who were referred to outpatient Pediatrics Neurology Clinics of Istanbul University Cerrahpaşa Medical School between 01.10.2003 ? 01.10.2009.25 (%14,8) Of the children were less than 6 months of age at the referral, 21 (%12,4) of them were between 6-12 months, 50 of them were between 12-24 months, and 73 (%43,2) of them were older than 24 months. As for the birth weight, it was <2500 g in 59 (%36,1) cases, and between 2500 - 4500 g in 104 (%63,8) cases. 108 (%66,2) Of the children were mature and 55 (%33,7) were premature babies at birth. 99 (%58,6) Of the children were products of vaginal delivery, 70 (%40,4) of them were delivered via cesarean section and 17 (%10) of them were born at home.If classified according to the type of the cerebral palsy, 144 cases (%86) were of the spastic, 13 cases(%7,7) were of the dyskinetic, 6 cases(%3,6) were of the mix type, and 5 cases(%3) were of the ataxic-hypotonic type. Of those children with spastic type cerebral palsy, 65 (%38,5) showed quadriparesis, 43 (%25,6) diplegia, 35 (%20,7) hemiparesis, and 2 (%1,2) monoparesis.92 (%54,4) Of the children showed 1 risk factor, 50 (%29,5) of them 2, and 19 (%11,2) > 3. The most common risk factor was found to be asphyxia which was present in 99 (%58,9) of the children. It was followed by low birth weight which was present in 61 (%36,1) cases, prematurity in 55 (%32,4). The rest of the risk factors found were as follows in the order of frequency: menenjitis was present in 7 (%4,1) cases, sepsis and other neonatal infections in 6 (%3,6), hyperbilirubinemia in 16 (%9,5), hydrocephaly in 5 (%3), genetical abnormalities in 5 (%3), vascular events such as intracranial hemorrhagy and thrombosis in 7 (%4,2), and acute metabolic events such as hypoglycemia in 1 (%0,6). In 8 cases (%4,7) there was found no risk factor. 38 (%22,5) Children were products of consanguinous marriages.Radiodiagnostic work-up revealed encephalomalasy being the most common finding in 45 (%26,6) cases. Other radiologic findings were as follows in the order of frequency: corpus callosum anomalies in 9 (%5,3), polimicrogyria in 5, holoprosencephaly and porencephalytic cyst in 2 cases each. Each of the following abnormality such as schisencephaly, choroid plexus cyst, Arnold-Chiari malformation was present in only one of our patiens. 33 Of the children had cortical atrophy, 18 had basal ganglia hyperintensity, 7 had cerebral infarcts, and 4 had hydrocephalus. In 15 cases (%8,9) there was no radiologic abnormality observed.In conclusion, gestational age and birth weight were believed to play significant roles in the etiopathogenesis of the occurence of cerebral palsy.