Magnetic resonance in children with dyskinetic cerebral palsy secondary to perinatal injury

Introduction. The incidence of perinatal factors in the dyskinetic cerebral palsy (DCP) is high. The introduction of the magnetic resonance (MR) has improved our understanding of the pathophysiology and early diagnosis of injury. Objective. Review the clinical characteristics of a group of patients with DCP and the appearance of their MR. Patients and methods. Retrospective study of 20 patients with DCP from 37 weeks of gestational age and perinatal injury with MR done. Results. The perinatal injury was: fetal distress (15 cases), severe hyperbilirubinaemia (I case) and neurological symptoms of unknown origin (3 cases). From the 15 patients with fetal distress, 10 had clinical manifestations of neonatal hypoxia-ischemia. The rest were clinical healthy. Seventeen patients had abnormal MR. Four of these had fetal distress without neonatal clinical manifestations. MR findings show high-intensity areas on T(2)-weighted images in the nucleus thalamus in 6 cases, putamen in 4, thalamus and putamen in 1, thalamus and pallidus in 2, thalamus and lenticular in 3 and in the lenticular alone in one case. In 5 cases hipointensity areas on T(1)-weighted images at the same sites were identified and in 1 case prolongation of T(1). In the child whose CDP was caused by severe hyperbilirubinaemia the MR was normal. Conclusions. The fetal distress occurring late in labour without neonatal hipoxic-ischemic manifestations can precede the developmental of DCP. Our observations support that in CDP resulting from perinatal injury the MR shows characteristic focal abnormalities in the basal ganglia (putamen and thalamus).