Magnetic resonance imaging (MRI) is now an important diagnostic technology in determining brain structure injury. It has important meaning for determining the pathological type of CP, MRI findings in CP showed a good correlation with CP type, gestational age, etiology and injury time. In this article, the authors reviewed the advance in research on relationship between changes in MRI and gestational age, etiology and injury time.

Brain ; pathology ; Caudate Nucleus ; pathology ; Child, Preschool ; Humans ; Huntingtin Protein ; Huntington Disease ; diagnosis ; genetics ; pathology ; Magnetic Resonance Imaging ; Male ; Nerve Tissue Proteins ; genetics ; Pedigree ; Trinucleotide Repeats ; genetics

The occurrence of epilepstic seizures in patients with cerebral palsy (CP) remains a serious event and is very disruptive for children who already suffered from orther disabilties. Data from population-based studies or neurodevelopmental clinic studies showed that 8%～62% of patients with CP suffer from epilepsy. The incidence is highest in spastic tetraplegia and hemiplegia. Half of the patients were onset within the first year of age. Children with tetraplegia CP tended to have an earlier onset of epilepsy than chlidren with other CP types. Partial seizures were the most common seizure types, followed by infantile spasms and Lennox-Gastaut syndrome. Low birth weight, neonatal seizures, family history of epilepsy, lower intelligence and grey matter damage were found to be related to significantly increased risk of epilepsy. Epilepsy in children wih CP usually had poor outcome, half of them were intractable and needed polytherapy. Only 37%～65.2% of patients became seizure-free.

Objective To characterize the language development and articulation in children with different types of cerebral palsy. Methods The data from 76 children with cerebral palsy who underwent standardized tests of speech and language were analyzed. The incidence and abnormal pattern were compared between groups. ResultsLanguage delay and/or dysarthria were noted in 73.1% of these subjects. Children with diplegia developed similar levels both in comprehension and verbal expression, whereas those with tetraplegia and athetoid developed poorer verbal expression. The incidence of language delay in children with diplegia, tetraplegia and athetoid were 45.95%, 90% and 64.7%, respectively. Dysarthria was found in all the children with tetraplegia, athetoid and ataxia, but only 48.65% of those with diplegia. Conclusion Language disorders were common in children with cerebral palsy, especially those with athetoid and tetraplegia.

Objective To analyze the comorbidities and gross motor function classifications (GMFCs) of premature children with cerebral palsy (CP) in terms of neurological subtype and gestational age in search of some relationship. Methods Children with cerebral palsy treated at the Qingdao Children's Hospital from 2006 to mid2009 received intelligence capacity tests, ophthalmological consultations, language/speech tests, brainstem auditory evoked potential measurements, electroencephalograms and GMFC evaluations. All of the children were stratified according to neurological subtype, gestational age, comorbidities and gross motor function classification. Results Of all 258 children, spastic diplegic cerebral palsy predominated (183 case, 70.9% ). 124 cases (48.1% ) had visual disorders, 121 (46.9%) had language or speech disorders and 103 (39.9%) showed mental retardation. The frequencies of individual comorbidities were distributed disproportionately between the different neurologic subtypes.GMFC levels also differed with the different CP types. The GMFC levels of diplegics were significantly better than those of the other types. The distribution of comorbidities such as visual disorders, language or speech disorders, and mental retardation was not related to gestational age or type of CP. Conclusions There is some correlation between the neurological subtype, comorbidities and the GMFC levels. But there is no significant correlation between gestation age and the severity of CP.

Objective To investigate neuroimaging and its correlation with clinical aspects of cerebral palsy (CP).Methods A retrospective study of 295 children with CP was conducted.Magnetic resonance imaging (MRI),the gross motor function classification system (GMFCS) and intelligence testing were administered,and any correlations among these measures was analysed.Results Among the 295 cases,257 presented abnormal MRIs (87.1％) due to brain maldevelopment (n =11),periventricular leukomalacia (PVL) (n =173),cortical/subcortical lesions (n =17),basal ganglia lesions (n =26),cerebellar maldevelopment (n =11) or others lesions (n =19).Thirty-nine presented with normal MRIs.About 26％ were rated at GMFCS level 1,18％ at level 2,17％ at level 3,19％ at level 4 and 20％ at level 5.Almost 82％ of the children presented with brain maldevelopment and 84.4％ with PVL-induced spastic bilateral paralysis.In 41％ of the children with cortical or subcortical lesions,induced spastic hemiplegia was observed,whereas 47％ had induced spastic bilateral paralysis.In 77％ of the children with basal ganglia lesions induced involuntary movement was observed,and all of those with maldevelopment of the cerebellum were ataxic.Most of those with spastic hemiplegic,bilateral paralysis,involuntary movement and ataxia were on GMFCS levels 1 or 2,with only 3.7％,33.5％,64.1％ and 46.2％ respectively on GMFCS level 4 or 5.Among those in whom the MRI revealed brain maldevelopment,9.1％ were on GMFCS level 1 or 2.The corresponding percentage for PVL was 43.9％,for cortical or subcortical lesions 58.8％,for basal ganglia lesions 19.2％ and for cerebellar maldevelopment 27.3％.The balance in each category were on GMFCS level 4 or 5.Epilepsy was most common in the children with brain maldevelopment (36.4％) or cortical or subcortical lesions (41.2％).Mental retardation was most common in cases of brain maldevelopment (45.5％),cortical or subcortical lesions (41.2％) or cerebellum maldevelopment (36.4％).The incidence of epilepsy and mental retardation was higher among the children on levels 4 and 5 than on levels 1 and 2.Conclusions Neuroimaging correlates significantly with the type of CP and GMFCS level.Epilepsy and mental retardation are most common in children with brain maldevelopment or lesions.The incidence of epilepsy and mental retardation is higher among children rated at GMFCS level 4 or 5 than among those on levels 1and 2.

Objective The technique of repetitive element-based polymerase chain reaction(rep-PCR)was used to track an epi- demic of nosocomial infection caused by Staphylococcus aureus in our hospital.Methods The 50 S.aureus isolates were identi fled by PHOENIX-100 automatic Microbiological Identification System.Oxacillin-salt-supplemented agar was used to screen methicillin-resistant S.aureus(MRSA)phenotype.The resistant gene mecA was tested by PCR.The technique of rep-PCR was applied to type S.aureus isolates.Results The mecA gene was identified in 22 of the 50 S.aureus isolates.Nineteen of the 22 strains were isolated from patients.Nine to eleven bands were observed in electrophoretic pattern of all the 50 S.aureus iso- lates by rep-PCR under the conditions of this study.These strains were accordingly classified into 11 different genotypes.Con- clusions The rep-PCR technique is a rapid,simple and reliable genotyping method.It is an ideal tool to track the source of noso- comial infections at molecular level.

Objective To investigate the relationship between magnetic resonance imaging(MRI) and the type of cerebral palsy (CP) and gestational age at birth.MethodsThe MRI and clinical data of 224 CP children with spastic type were analyzed retrospectively.ResultsAmong these children, 27 cases had spastic hemiplegia, 149 had spastic diplegia, and 48 had spastic tetraplegia. 201 cases (89.7%) had abnormal MRI result. The abnormal rate of MRI in spastic hemiplegia, diplegia and tetraplegia were 100%, 87.2% and 91.7%, respectively. Periventricular leukomalacia (PVL) was observed mostly in children with spastic diplegia, other types of brain lesions were uncommon. In spastic tetraplegia the lesions were more varied. Three predominated types of MRI abnormalities were: PVL (45.8%), term-type brain injuries (20.8%) and congenital brain abnormalies (18.8%). Unilateral lesions were observed mostly in children with hemiplegia spastic diplegia born at term who showed unilateral motor disorder and upper extremity were heavier than lower extremity. Unilateral and bilateral PVL were observed in children with hemiplegia spastic diplegia born at preterm who showed lower extremity were heavier than upper extremity. Of 152 cases with PVL, 108 cases (71.1%) were preterm infants and 44 cases (28.9%) were term infants. Of 22 cases with term-type brain injuries, 20 cases (90.9%) were term infants. PVL was most observed in preterm brain injuries and was observed most in preterm children but was also in term children. Term-type brain injuries (border-zone infarct, basal ganglia-thalamic lesion, subcortical leukomalacia, and multicystic encephalomalacia) were observed most in term and rare in preterm children.ConclusionThe MRI findings in CP show a good correlation with type of CP and gestational age.

Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.

ObjectiveTo study the risk factor, semeiology and neuroimaging abnormalities of dyskinetic cerebral palsy.MethodsA hospital-based study, 136 children with dyskinetic cerebral palsy were examined neurologically and their perinatal history was reviewed. Their cranial CT or MRI findings were studied. The association between the gestational ages, CP types and the radiological appearances were analyzed.Results124 cases (91.18%) were found obviously risk factors, including asphyxia (34 cases), pathological hyperbilirubinemia (70 cases), both asphyxia and hyperbilirubinemia (11 cases) and others (8 cases). According to the clinical and neurological features, 60 (44.12%) were chorea-athetoid cerebral palsy, 26 (19.12%) were dystonic cerebral palsy, and 50 (36.76%) were athetoid-spastic cerebral palsy. Those with asphyxia were mainly athetoid-spastic whereas cases with pathological hyperbilirubinemia were mainly chorea-athetoid cerebral palsy. The abnormal rates of cranial MRI scans was 52.9%, and it was higher in the group of asphyxia than pathological hyperbilirubinemia, preterm than term. The main findings on MRI scans were as follows: periventricular leucomalacia(PVL) 28 (38.8%), diffuse bilateral atrophy 20 (27.8%), focal abnormalities in the basal ganglia1 and/or temporal lobe 18 (24.0%).ConclusionMRI abnormalities of the brain were correlated with semeiologic subtypes, risk factors, and the gestational age at birth.