Cerebral Palsy ; mortality ; pathology ; physiopathology ; Child ; Humans ; Prognosis ; Survival Analysis ; Survival Rate ; Time Factors ; Walking

OBJECTIVETo measure gray matter volume of whole brain with voxel-based morphometry (VBM) method and to study brain structures associated with gross motor function.

METHODForty children with cerebral palsy were recruited in the authors' hospital from Oct. 2012 to Dec. 2013 (26 male, 14 female cases, average age (3.6 ± 2.0) years ). Gross motor function classification system (GMFCS) for children was used to obtain their motor function. The whole-brain three dimensional magnetic resonance imaging (MRI) was performed on a 3.0 T MRI scanner. The data were segmented by VBM 5, and the whole brain volumes of gray matter, white matter and cerebospinal fluid were produced. Correlation analysis was used to analyze the correlation of GMFCS with whole brain volumes using SPM 5 in Matalab 7.1.

RESULTThe volume in left meditemporal gyrus (Z=3.57) and inferior temporal gyrus (Z=3.40), right thalamus and pallidum (Z=3.36), left thalamus and pallidum (Z=2.76), left supramarginal gyrus (Z=3.14), left precuneus gyrus (Z=3.00), right dorsolateral superior frontal gyrus (Z=3.08), right superior and medial occipital gyrus (Z=2.84) significantly increased as aggravation of gross motor dysfunction. The volume of the left medial orbitofrontal lobe and anterior cingulate (Z=3.28,3.02), left medial superior frontal gyrus (Z=3.19), left caudate (Z=3.04, 2.94, 2.92), left cerebellum (Z=2.94), right cerebellum (Z=2.97), left parahippocampal (Z=3.94), right parahippocampal (Z=3.43, 3.00), left insula (Z=3.50), right insula (Z=3.41, 3.80), left lingual (Z=3.37), right lingual (Z=3.30), left post cingulum (Z=2.73), left midioccipital gyrus (Z=2.92) and right miditemporal gyrus (Z=3.05) significantly reduced as the aggravation of gross motor dysfunction (P all<0.005).

CONCLUSIONGMFCS in children with cerebral palsy is related to abnormalities of brain gray matter structure for motor, emotion, memory and default model network when examined with VBM method.

Cerebral Palsy ; physiopathology ; Child, Preschool ; Female ; Gray Matter ; pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male

OBJECTIVETo study the clinical and neurological abnormalities in children with cerebral palsy (CP) and to attempt to correlate the types of CP and the gestational age at birth with radiological abnormalities detected by magnetic resonance imaging (MRI) of the brain.

METHODSThis is a hospital-based study, the subjects included 104 children with cerebral palsy who were hospitalized in the Qingdao Rehibilitation Center For Disabled Children. All the 104 hospitalized CP cases (47 with spastic diplegia, 9 with tetraplegia, 15 with hemiplegia, 22 with athetosis, and 11 with ataxia) were examined neurologically and their perinatal history was reviewed. Their cranial MRI findings were studied. The association between the gestational ages, CP types, and the radiological findings were studied.

RESULTSThe type distribution was significantly different between term- and preterm- infants. Spastic diplegia was the main type in preterm infants while hemiplegia and ataxia were mainly seen in term infants. MRI abnormalities were found in 88 of the 104 cases and abnormal rates of spastic diplegia, tetraplegia, hemiplegia, athetosis, and ataxia were 89.4%, 100%, 100%, 54.5% and 90.9%, respectively. There was no significant difference in abnormal rates between term and preterm groups. Thirty-one of 42 (73.8%) children with spastic diplegia had significant periventricular leukomalacia (PVL), which was more common among preterm-born children (90%). Of the 15 children with hemiplegia, 13 had unilateral lesions on neuroimaging. Spastic tetraplegia was associated with extensive, bilateral, diffuse brain damage. The abnormalities in term-born infants with athetoid cerebral palsy were mainly located in the basal ganglia region whereas the major abnormality in premature infants was PVL. Of the 11 children with ataxic cerebral palsy, 8 cases showed congenital cerebellum dysplasia on brain imaging.

CONCLUSIONSRadiological abnormalities of the brain were correlated with CP types and the gestational age at birth; MRI scan was useful in revealing underlying brain abnormalities and speculating on the etiology of cerebral palsy.

Cerebral Palsy ; classification ; pathology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male

Despite improvement in perinatal practice during the past several decades, the incidence of cerebral palsy has remained essentially unchanged. The cause of cerebral palsy is thought to be multifactorial, including prematurity, inflammation, genetic cause and environmental factors. Although evidences suggest that 70-80% of cerebral palsy is due to prenatal factors and birth asphyxia plays a relatively minor role (<10%), development of cerebral palsy is frequently attributed to the obstetric misstep. Therefore, it is of critical importance to keeping in touch with recent trend and advances regarding cerebral palsy. In this background, this review was mainly focused on the articles published from Jan 2006 to June 2007, excluding the orthopedic and rehabilitational aspects. The subjects are arbitrary divided into the following four categories; 1) recent epidemiologic studies of cerebral palsy, 2) recent evidences of antenatal risk factors, 3) cerebral palsy and placental pathology, 4) role of MRI in diagnosis of cerebral palsy.
Asphyxia ; Cerebral Palsy* ; Diagnosis ; Epidemiology ; Incidence ; Inflammation ; Magnetic Resonance Imaging ; Orthopedics ; Parturition ; Pathology ; Risk Factors

OBJECTIVE: To find out the characteristics of the foot pressure distribution and the path of center of pressure (COP) in the children with cerebral palsy, compared with normal control children. METHOD: Twenty-four children with spastic cerebral palsy(CP) and 38 normal children were participated in this study. The parameters of foot contact, plantar pressure and COP were measured using F-scan system (Teksan Inc.) with pressure ensitive insoles inserted in the shoes. RESULTS: The total contact area, mid foot contact width and also the pressure of hallux and medial side of mid foot were significantly higher in the children with CP than in normal controls. While the pressure of hind foot was significantly lower in the children with CP compared with normal controls. Anteroposterior distance and velocity of COP were significantly lowered in the cerebral palsied children. The paths of COP of both groups were directed inwardly without any significant differences between both groups. CONCLUSION: We can identify the characteristics of the foot pressure distribution and the path of COP in the children with spastic CP using F-scan system. These quantitative data of foot scan may be useful for evaluating the foot pathology during the gait in the children with CP.
Cerebral Palsy* ; Child* ; Foot* ; Gait ; Hallux ; Humans ; Muscle Spasticity* ; Pathology ; Shoes ; Walking*

OBJECTIVE: To find out the characteristics of foot pressure in children with mild spastic diplegic cerebral palsy over 7 years old compared with those of normal children. METHOD: Twenty children with mild spastic diplegic cerebral palsy and fourteen normal children over 7 years old articipated in this study. The foot was divided into 7 portions and then foot contact area, pressure of each foot portion and pathway of center of pressure (COP) were measured and analyzed by F-scan system (Tekscan Inc., USA) RESULTS: In children with cerebral palsy, first metatarsal area MET1) showed the highest relative impulse followed by MET2/3, hindfoot and hallux. Relative impulse of hallux, MET1 and medial midfoot were significantly higher in cerebral palsied than in normal children, while that of hindfoot was significantly lower in cerebral palsied than in normal children. Anteroposterior ratio of COP and gait velocity were significantly lower in cerebral palsied than in normal children. CONCLUSION: The characteristics of foot pressure distribution and the pathway of COP in children with mild spastic diplegic cerebral palsy were identified by quantitative analysis by F-scan system. Foot scan could be used for eval uating the foot pathology in children with cerebral palsy during gait.
Cerebral Palsy* ; Child* ; Foot* ; Gait ; Hallux ; Humans ; Metatarsal Bones ; Muscle Spasticity* ; Pathology

OBJECTIVE: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy. METHOD: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups. RESULTS: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different. CONCLUSION: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.
Ankle ; Cerebral Palsy* ; Child* ; Classification ; Foot ; Gait* ; Hip ; Humans ; Joints ; Knee ; Muscle Spasticity* ; Pathology ; Tibia ; Walking

In this study, we reported a case of progressive pseudorheumatoid dysplasia in Peking University Third Hospital. A 56-year-old male patient presented with hip joint pain for more than 40 years and multiple joints pain with limitation of movements of these joints for 28 years. This patient suffered from joint pain and impaired range of motion of the hip, knee, elbow and shoulder gradually, associated with difficulty in walking and inability to take care of himself. He was diagnosed with "femoral head necrosis" or "ankylosing spondylitis" in local hospitals, but the treatment of nonsteroidal antiinflammatory drugs (NSAIDs) and sulfasalazine was not effective. Up to the age of 14, the patient displayed normal physical development, with the highest height was about 158 cm, according to the patient recall. However, his height was 153 cm at present. There was no history of similar illness in any family member. Physical examinations descried limitation of movement of almost all joints. Enlargement and flexion deformity of the proximal interphalangeal (PIP) joints of the hands resulted in the claw hand appearance. Limited abduction and internal and external rotation of the shoulder and hip could be find. He had normal laboratory findings for blood routine test, biochemical indexes and acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Furthermore, HLA-B27 and autoimmune antibodies such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear antibody (ANA) were all negative. X-ray of the hip showed loss of the joint space and irregularities of the femoral head, both femoral head were flattened, it could be see hyperplasia, osteophytes, bilateral femoral neck thicken, neck dry angle turned smaller. The radiological findings of the spinal vertebra indicated kyphosis deformity, narrowing of the intervertebral discs, vertebral syndesmophytes and flattening of the vertebra. However, there was no clues of bone marrow edema in the lumbar MRI. At last, genetic testing for the Wnt1-inducible signaling pathway protein 3 (WISP3) gene was done and indicated compound heterozygous mutations: 756C>G and c.866dupA. These two mutations were derived from the patient's mother and father (the patient's parents each had a heterozygous mutation). Two exons of the WISP3 gene had nucleotide changes leading to amino acid mutations. According to the patient's history, symptoms, physical examinations, radiological findings and genetic testing, the final definitive diagnosis was progressive pseudorheumatic dysplasia.
Cerebral Palsy ; Heterozygote ; Hip/pathology* ; Humans ; Joint Diseases/etiology* ; Male ; Microcephaly ; Middle Aged ; Spondylitis, Ankylosing/diagnosis*

OBJECTIVETo study pathologic features of glial cells in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) and to explore their pathologic significance.

METHODSBrain tissues from 2 cases with PSP and 3 cases with CBD, all confirmed by autopsies, were examined by routine neuropathologic methods, Gallyas-Braak staining and tau immunostaining. Brain tissues from 6 Alzheimer's disease cases, 4 cases with Parkinson's disease and 6 elderly with no neurologic abnormality were used as controls.

RESULTSGallyas-Braak staining demonstrated tuft-shaped astrocytes and coiled-body oligodendroglial cells in the brain tissues of 2 cases with PSP and 3 cases with CBD. The tuft-shaped astrocytes appeared prominently in the frontal and parietal cortex, basal ganglia and grey matter of the brainstem. The coiled-body oligodendroglial cells were distributed widely in the white matter of the frontal and parietal lobes, basal ganglia, brainstem and cerebellum. However, astrocytic plaques, composed of degenerative stubby processes with radiating arrangement, only appeared in the frontal, parietal and cingular cortex, as well as in the striatum of 3 cases with CBD. The astrocytic plaques and tuft-shaped astrocytes coexisted in the same areas, including parietal and cingular cortex and striatum, in CBD. All these glial abnormalities showed tau-positive immunoreaction not found in control cases.

CONCLUSIONSThe tuft-shaped astrocytes and coiled-body oligodendroglial cells are common glial morphologic features of both PSP and CBD. Astrocytic plaques are also characteristically seen in CBD.

Aged ; Aged, 80 and over ; Astrocytes ; pathology ; Basal Ganglia ; pathology ; Brain Stem ; pathology ; Cerebral Cortex ; pathology ; Humans ; Male ; Neurodegenerative Diseases ; pathology ; Oligodendroglia ; pathology ; Supranuclear Palsy, Progressive ; pathology

PURPOSE: This study aimed to investigate useful parameters for estimating gastrocnemius (GCM) muscle volume (MV) using ultrasonography (US) and anthropometry in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: Eighteen legs from nine children with spastic CP aged 2 to 6 years were investigated in this study. Tibial length (TL) of each leg was measured and muscle thickness (MT) and anatomical cross-sectional area (aCSA) of GCM muscles were assessed using US. The volume of the GCM was measured by magnetic resonance imaging (MRI) scans. The relationship of TL, MT, and aCSA with MV measured by MRI was investigated. Simple and multiple regression analyses were performed to establish muscle volume prediction equations. RESULTS: Resting MT, aCSA, and TL were highly related to MV of both medial and lateral head of GCM determined by MRI. The MV prediction equation based on simple regression analysis resulted in r2 values ranging from 0.591 to 0.832 (p<0.05). The r2 values were higher using aCSA as independent variable than using MT. The MV prediction equation based on multiple regression analysis resulted in r2 values ranging from 0.779 to 0.903 (p<0.05). However, the relatively high standard error of the estimate values ranged from 18.0-33.6% on simple regression and 15.5-25.6% on multiple regression. The contribution of aCSA was higher than that of MT for predicting MV of GCM. CONCLUSION: Our study demonstrated the suitability of US assessment of aCSA and MT combined with TL for estimating MV of GCM in children with spastic CP and showed that aCSA is more useful parameter than MT.
Cerebral Palsy/*pathology/ultrasonography ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Muscle, Skeletal/*pathology/ultrasonography