Computed tomography findings in cerebral palsy in Yaoundé – Cameroon

ABSTRACT: Background : Cerebral palsy is a neuro-developmental condition beginning in early childhood and persisting throughout life. It is the leading cause of childhood disability affecting function and development. Neuro-imaging, with magnetic resonance imaging being the chief cornerstone, plays a vital role in determining the presence and extent of brain injury, with the possibility of determining the age of the lesions, the prognosis and also depicting concurrent or other mimicking lesions. Aim : To determine and describe common brain lesions of cerebral palsy patients on CT in Yaounde (Cameroon) where magnetic resonance imaging is still not widely available and accessible. Materials and methods : It was a cross-sectional descriptive study carried out at the Radiology and Pediatric units of a university-affiliated hospital in Yaounde. Consecutive and complete records of all patients with a clinical diagnosis of cerebral palsy who had a head CT scan performed between September 2009 and February 2012 were reviewed. Results: One hundred and twenty patients’ records were reviewed for the study, of which there were 66 females (sex-ratio 0.8). The mean age of the study population was 42 months with 77.4% aged 0 to 60 months. The most frequent associated clinical signs were language impairment (45.6%), mental retardation (40.2%) and epilepsy (37.8%). Spastic quadriplegia was the most frequent (26.67%) clinical subtype followed by spastic hemiplegia (15.83%). CT findings were observed in 90 percent of all the scans performed. Diffuse brain atrophy (52.7%) and cerebral hypodensities (45.4%) were the most frequent imaging findings. Atrophy was mostly cortical and sub-cortical (49.1%) while hypodensities affected the middle cerebral artery territory in 55.1% of cases. Parenchymal calcifications were seen in 11 cases (10.2%) of which two cases of confirmed CMV infections. Brain malformations were founded in eighth patients. Conclusion: . Spastic quadriplegia and infantile cerebral hemiplegia were the most frequent cerebral palsy types. Diffuse brain atrophy, and parenchymal hypodense areas constitute frequent CT findings in patients with CP. Normal 0 21 false false false FR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tableau Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Keywords: Cerebral palsy, Computed tomography, Diffuse brain atrophy, Cerebral hypodensities, Spastic quadriplegia, Infantile cerebral hemiplegia , Cameroon. RESUME : Objectif . En l’absence d’IRM, decrire au scanner les principales anomalies cerebrales dans une population d’enfants atteints de paralysie cerebrale a l’Hopital Gyneco-Obstetrique et Pediatrique de Yaounde (Cameroun). Materiel et methodes . Etude transversale descriptive incluant tous les enfants avec un diagnostic clinique de paralysie cerebrale et ayant effectue un scanner cerebral entre septembre 2009 et fevrier 2012a HGOPY. Resultats . Cent-vingt enfants etaient inclus dont 66 filles. L'âge moyen etait de 42 mois avec77,4% d’enfants âges de 0 a 5ans. Les troubles de langage (45,6%), le retard mental (40,2%) et l’epilepsie (37,8%) etaient les principaux signes cliniques associes. La tetraparesie spastique etait la forme la plus frequente (26,67%) suivie de l’hemiplegie cerebrale infantile (15,83%). Le scanner etait pathologique dans 108cas (90%). L’atrophie cerebrale (52,7%) et les hypodensites parenchymateuses (45,4%) etaient les anomalies les plus frequentes. L’atrophie etait a predominance cortico-sous-corticale (49,1%) alors que les hypodensites interessaient le territoire de l’artere cerebrale moyenne dans 55,1%. Les calcifications parenchymateuses etaient observees dans 11 cas (9,1%) dont deux cas confirmes d’infection a CMV. Les malformations etaient associees dans huit cas (6,6%). Conclusion . La tetraparesie spastique et l’hemiplegie cerebrale infantile etaient les formes de paralysie cerebrale les plus frequentes. L’atrophie cerebrale diffuse et les hypodensites constituaient les principales anomalies scanographiques. Normal 0 21 false false false FR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tableau Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Mots-cles : Paralysie cerebrale, Scanner, Hypodensites cerebrales, Tetraparesie spastique, Hemiplegie cerebrale infantile, Cameroun. Cerebral palsy, Computed tomography, Diffuse brain atrophy, Cerebral hypodensities, Spastic quadriplegia, Infantile cerebral hemiplegia , Cameroon Normal 0 21 false false false FR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tableau Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}