Çocuk Nörolojisi Bilim Dalına 01.10.2003-01.10.2009 yılları arasında başvuran serebral palsili olguların klinik ve laboratuvar bulgularının değerlendirilmesi
The results of the clinical and laboratory findings of children with cerebral palsy who were admitted to the Pediatric Neurology Department between 01.10.2003 and 01.10.2009
Yazar: HANDAN HAKYEMEZ TOPTAN
Danışman: PROF. DR. SABİHA KESKİN
İstanbul Üniversitesi / Cerrahpaşa Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
Dizin: Nöroloji = Neurology ; Prognoz = Prognosis ; Serebral palsi = Cerebral palsy ; Çocuklar = Children

Özet:
01.10.2003 ? 01.10.2009 yılları arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Nöroloji Bilim Dalı polikliğine başvuran; ortalama başvuru yaşı 27,3 ±26,1 ay ve 96 (%56,8)`sı erkek, 73 (%43,2)'ü kız çocuğu 169 SP'li olgunun klinik ve laboratuvar bulguları geriye dönük incelendi.Olguların 25 (%14,8)'i <6 aylık; 21 (%12,4)'i 6-12 aylık, 50 (%29,6)'si 12-24 aylık ve 73 (%43,2)'ü >24 aylık iken başvurmuştu. Olguların doğum ağırlığı 59 (%36,1) olguda <2500 g; 104 (%63,8) olguda 2500 - 4500 gr idi. 108 (%66,2) olgu term, 55 (%33,7)'i pretermdi. 99 (%58,6) olgu vajinal yolla, 70 (%40,4)'i sezeryan ile doğmuştu. Vajinal doğumların 17 (%10)'si evde gerçekleşmişti.Serebral palsi tiplerine göre ayrıldığında; 144 (%86) olgu, spastik tip; 13 (% 7,7) olgu diskinetik tip; 6 (% 3,6) olgu mikst tip ve 5 (%3) olgu ataksik-hipotonik tipti. Spastik tiplerin 65 (%38,5)'i kuadriparezik; 43 (%25,6)'ü diplejik; 35 (%20,7)'i hemiparezik ve 2 (%1,2)'si monoparezikti.Risk faktörlerinden en sık asfiksi 99 (%58,9) görüldü. Onu sıklık sırasına göre, düşük doğum ağırlığı 61 (%36,1); prematürite 55 (%32,5) ve 7 (%4,1) olguda menenjit ve 6 (% 3,6) olguda sepsis izledi. Hiperbilirubinemi 16 (%9,5), hidrosefali 5 (%3) ve genetik anomaliler 5 (%3), intrakranial hemoraji ve tromboz gibi vasküler prosesler 7 (%4,2), hipoglisemi 1 (%0,6) idi. Olguların 8'sinde (%4,7) herhangi bir risk faktörü saptanmadı. 38 (%22,5) Olgunun anne babasında akraba evliliği mevcuttu.Olguların görüntüleme bulgularına göre; 45 (%26,6)'inde ensefalomalazi, 9 (%5,3)'unda corpus callosum anomalisi; 5 (%3)'inde polimikrogri; 2'sinde (%1,2) holoprosensefali; 2`sinde (%1,2) porensefalik kist; 1'inde (%0,6) şizensefali; 1'inde (%0,6) koroid pleksus kisti; 1'inde (%0,6) Arnold-Chiari malformasyonu, 33 (%19,5)'ünde kortikal atrofi; 18 (%10,6)'inde bazal ganglia hiperintensitesi; 7 (%4,1)'sinde serebral infarkt ve 4 (%2,4)'ünde hidrosefali vardı. 15 (%8,9)'inde görüntüleme normaldi.Sonuç olarak, çalışma sonuçlarımız intrauterin gelişmenin önemli kriterlerinden olan gebelik yaşı ve doğum tartısının SP etyopatogenezi ve SP prognozunda önemli bir rol oynadığı iddiasını doğrular niteliktedir.

Abstract:
This is a retrospective study on the clinical and laboratory findings of 169 children of ages between 2 mo.-13 years (mean 27.3±26,1 mo.) with cerebral palsy, of whom 96 (%56,8) were males and 73 (%43.,2) were girls who were referred to outpatient Pediatrics Neurology Clinics of Istanbul University Cerrahpaşa Medical School between 01.10.2003 ? 01.10.2009.25 (%14,8) Of the children were less than 6 months of age at the referral, 21 (%12,4) of them were between 6-12 months, 50 of them were between 12-24 months, and 73 (%43,2) of them were older than 24 months. As for the birth weight, it was <2500 g in 59 (%36,1) cases, and between 2500 - 4500 g in 104 (%63,8) cases. 108 (%66,2) Of the children were mature and 55 (%33,7) were premature babies at birth. 99 (%58,6) Of the children were products of vaginal delivery, 70 (%40,4) of them were delivered via cesarean section and 17 (%10) of them were born at home.If classified according to the type of the cerebral palsy, 144 cases (%86) were of the spastic, 13 cases(%7,7) were of the dyskinetic, 6 cases(%3,6) were of the mix type, and 5 cases(%3) were of the ataxic-hypotonic type. Of those children with spastic type cerebral palsy, 65 (%38,5) showed quadriparesis, 43 (%25,6) diplegia, 35 (%20,7) hemiparesis, and 2 (%1,2) monoparesis.92 (%54,4) Of the children showed 1 risk factor, 50 (%29,5) of them 2, and 19 (%11,2) > 3. The most common risk factor was found to be asphyxia which was present in 99 (%58,9) of the children. It was followed by low birth weight which was present in 61 (%36,1) cases, prematurity in 55 (%32,4). The rest of the risk factors found were as follows in the order of frequency: menenjitis was present in 7 (%4,1) cases, sepsis and other neonatal infections in 6 (%3,6), hyperbilirubinemia in 16 (%9,5), hydrocephaly in 5 (%3), genetical abnormalities in 5 (%3), vascular events such as intracranial hemorrhagy and thrombosis in 7 (%4,2), and acute metabolic events such as hypoglycemia in 1 (%0,6). In 8 cases (%4,7) there was found no risk factor. 38 (%22,5) Children were products of consanguinous marriages.Radiodiagnostic work-up revealed encephalomalasy being the most common finding in 45 (%26,6) cases. Other radiologic findings were as follows in the order of frequency: corpus callosum anomalies in 9 (%5,3), polimicrogyria in 5, holoprosencephaly and porencephalytic cyst in 2 cases each. Each of the following abnormality such as schisencephaly, choroid plexus cyst, Arnold-Chiari malformation was present in only one of our patiens. 33 Of the children had cortical atrophy, 18 had basal ganglia hyperintensity, 7 had cerebral infarcts, and 4 had hydrocephalus. In 15 cases (%8,9) there was no radiologic abnormality observed.In conclusion, gestational age and birth weight were believed to play significant roles in the etiopathogenesis of the occurence of cerebral palsy.