CT Scanning Findings in Clinically Diagnosed Cerebral Palsy

Background: Cerebral Palsy is a non-progressive disorder due to insult in the developing brain. This causes disorders in muscle tone, posture and movement. Cerebral palsy is usually diagnosed by clinical features. Though risk factors are identified in about 75% of cases, the etiology remains unclear. Magnetic resonance imaging is the standard method to detect central nervous system abnormalities; but in resource poor areas CT Scanning may be an alternative method to elucidate the underlying Central Nervous System abnormalities. Objectives: The objective was to detect CT Scanning findings in different types of Cerebral palsies. Methodology: This was a prospective and cross-sectional study conducted on 525 Children registered at Child Development Center attached to Rangpur Mother and Children Hospital. Cerebral palsy was diagnosed by using an Interview Schedule. During from 1.1.2016 to 31.12.2019 CT scanning of brain was performed purposefully to all children to detect the underlying Central Nervous System abnormalities. The purpose was explained to parents and consent was taken before performing the tests. The children were in sedation during the procedure. Result: A total of 1800 registered children, 525 (29.10%) children were suffering from Cerebral Palsy. The male and female ratio was 3:2 and age distribution was 2.6±1.5 years. Seventy nine percent (79.0%) of children came from poor families. Parental education up to class V was in 65% cases. Maximum number (63.0%) of cases was suffering from spastic type of Cerebral Palsy followed by athetoid type (18.3%) and 7.1% ataxic type. Among spastics, quadriplegia was present in 68.5% of cases followed by hemiplegia (18.5%). Perinatal asphyxia was the commonest (56.1%) risk factor of Cerebral Palsy. Among all the CTs 116 (22.0%) were with normal finding and 409 (78.0%) were with various types of abnormal findings. White Matter Injury was present in 79 (15.0%) of cases and among these volume loss in periventricular areas with ventricular dilatation and deep white matter damage was common. The next abnormalities were Focal Vascular Insults (9.0%), Malformations (5.0%) and Unclassified lesions (4.0%). Grey Matter Injury was common in spastic type of cerebral palsy but there was much overlapping of abnormal findings and most (66.3%) insults occurred in perinatal period. Conclusion: CT scanning of brain is a comparable test to detect the central nervous system abnormalities in resource poor areas. Grey matter injury is the common abnormality in Cerebral palsy but there is much overlapping between CT Scanning findings and clinical diagnosis. J Bangladesh Coll Phys Surg 2022; 40: 31-38

Brain Magnetic Resonance Imaging Pattern in Cerebral Palsy

Background Cerebral palsy (CP) leads to a common static motor neurological disease in children that can be demonstrated with varied neuroimaging findings. Magnetic Resonance Imaging (MRI) has a vital role of determining the presence of brain injury and its extent, with any possibility of determining pathogenic pattern and disease severity. The objective of the study is to evaluate the neuroimaging findings in CP and their correlation to disease severity. Method The research was case-control study, consecutive and complete records of all patients who had a clinical diagnosis of CP and performed a head MRI between 2018 and 2019 were enrolled in this study. Cases group were children diagnosed as severe CP with The Gross Motor Function Classification System (GMFCS) IV-V. Control group were children confirmed as CP with GMFCS I-III. Brain imaging was examined by MRI, in which the abnormalities were classified into grey matter or white matter injury, focal vascular disorder and brain malformation. Kruskal-Wallis statistical analysis was applied to identify the correlation. Results Almost 60 cases were reviewed. White matter injury, malformation and focal vascular insult were not correlated significantly to CP severity (OR = 0.73; 95% CI = 0.2-2.2; p = 0.78 and OR = 0.61; 95% CI = 0.2-1.9; p = 0.57 and OR = 2.034; 95% CI = 0.51-0.76; p = 0.63, respectively). Grey matter injury was more frequent discovered in severe CP (50%) and increased the risk of CP severity (OR = 9; 95% CI = 2.2 – 36; p = 0.002). Conclusion Grey matter injury is considered the most frequent abnormalities of Brain MRI in CP and it could increase the risk of severity.

Computing Brain White and Grey Matter Injury Severity in a Traumatic Fall

In the real world, the severity of traumatic injuries is measured using the Abbreviated Injury Scale (AIS). However, the AIS scale cannot currently be computed by using the output from finite element human computer models, which currently rely on maximum principal strains (MPS) to capture serious and fatal injuries. In order to overcome these limitations, a unique Organ Trauma Model (OTM) able to calculate the threat to the life of a brain model at all AIS levels is introduced. The OTM uses a power method, named Peak Virtual Power (PVP), and defines brain white and grey matter trauma responses as a function of impact location and impact speed. This research has considered ageing in the injury severity computation by including soft tissue material degradation, as well as brain volume changes due to ageing. Further, to account for the limitations of the Lagrangian formulation of the brain model in representing hemorrhage, an approach to include the effects of subdural hematoma is proposed and included as part of the predictions. The OTM model was tested against two real-life falls and has proven to correctly predict the post-mortem outcomes. This paper is a proof of concept, and pending more testing, could support forensic studies.

Regional Differences in Susceptibility to Hypoxic-Ischemic Injury in the Preterm Brain: Exploring the Spectrum from White Matter Loss to Selective Grey Matter Injury in a Rat Model

Models of premature brain injury have largely focused on the white matter injury thought to underlie periventricular leukomalacia (PVL). However, with increased survival of very low birth weight infants, injury patterns involving grey matter are now recognized. We aimed to determine how grey matter lesions relate to hypoxic-ischemic- (HI) mediated white matter injury by modifying our rat model of PVL. Following HI, microglial infiltration, astrocytosis, and neuronal and axonal degeneration increased in a region-specific manner dependent on the severity of myelin loss in pericallosal white matter. The spectrum of injury ranged from mild, where diffuse white matter abnormalities were dominant and were associated with mild axonal injury and local microglial activation, to severe HI injury characterized by focal MBP loss, widespread neuronal degeneration, axonal damage, and gliosis throughout the neocortex, caudate putamen, and thalamus. In sum, selective regional white matter loss occurs in the preterm rat concomitantly with a clinically relevant spectrum of grey matter injury. These data demonstrate an interspecies similarity of brain injury patterns and further substantiates the reliable use of this model for the study of preterm brain injury.