American Academy for Cerebral Palsy and Developmental Medicine
Multidisciplinary scientific society devoted to the study of cerebral palsy and other childhood onset disabilities, to promoting professional education for the treatment and management of these conditions, and to improving the quality of life for people with these disabilities. www.aacpdm.org/
Cerebral Palsy Quick Reference and Fact Sheets for Professionals
Center on Human Development and Disability, University of Washington. Diagnostic and management considerations for primary care providers; links to CP websites and family support.
Neuroimaging modalities show pathology by CT scan in 77% of patients with cerebral palsy and by MRI in 89%. (Ashwal S et al, Neurology, 62:851-853, 2004.) Conventional and functional MR may show precise relationships between structural lesions and motor disability. (Flodmark O. Definition and Classification of Cerebral Palsy: The brain imaging perspective. Devel Med Child Neurol: Supplement. 49:18-19, 2007.)
Timing of neuroradiologic findings (Flodmark O. Definition and Classification of Cerebral Palsy: The brain imaging perspective. Devel Med Child Neurol: Supplement. 49:18-19, 2007, and Krageloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Devel Med Child Neurol. 49:144-151, 2007.)
First Trimester: Abnormalities of cleavage of the central nervous system (such as holoprosencephaly) occur in 4th to 6th week of gestation
Abnormalities of cortical organiziation occur later in gestation, e.g. polymicrogyria may occur as late as 20 weeks or later depending on specific type
Early Third Trimester: Primary white matter lesions, such as periventricular leukomalacia, occur around 24 weeks (perhaps earlier) until 34 weeks gestation. 'When found in a neonate born at term, PVL should be considered as having occurred in utero.' Anterior white matter damage is likely a sign of an earlier central nervous system insult than posterior damage. Neuroradiologic findings of PVL can be found in 32% of preterm infants at risk while only 9% developed CP. (Olsen P et al. Pediatrics. 102:329-336, 1998.) However, children with PVL may have visual cognitive deficits without motor findings. (Jacobsen L et al. Surv Ophthalmol. 45:1-13, 2000.)
Late Third Trimester and Close to Term: Grey matter is more sensitive to injury than white matter - cortical and/or deep grey matter, such as basal ganglia and thalamus.
Profound asphyxia may lead to bilateral symmetrical damage to thalami, posterior putamen and Rolandic cortex
Partial asphyxia close to term is thought to cause diffuse damage to cortical structures
Focal cortical damage (often in the distribution of the middle cerebral artery) is thought to be related to hereditary or acquired thrombophilias and environmental factors.
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