Cerebral palsy: risk factors, comorbidities and associated MRI findings, a hospital based observational study

Field: Medicine (Health Sciences)

Background: Cerebral palsy is a common pediatric disorder occurring in about 2-2.5/1000 live births. It is a chronic motor disorder resulting from a non-progressive static insult to the developing brain. There are various risk factors associated with it. Also it is accompanied with varied comorbidities and MRI findings depending on the etiology. Aims and objectives: To study the various risk factors, comorbidities and MRI findings in patients with cerebral palsy patients. Methods: A hospital based observational study was undertaken in the post graduate department of pediatrics, GB pant hospital, GMC Srinagar, Northern India. The study was carried out over a period of one year from September, 2009 to August 2010. During this year 22036 patients were admitted in this hospital, of which 2077 (9.42%) were neurological cases. Of these 2077 neurological cases, 145 (6.98%) were cerebral palsy patients, however only 57 children were included in our study. Other 88 CP cases were excluded as they were not fulfilling the inclusion criteria. After thorough clinical history and examination relevant investigations were done including MRI brain. Results: The commonest type of CP was spastic diplegia 28 (49.1%). Other types were spastic quadriplegia in 11 (19.29%), spastic hemiplegia 11 (19.29%), choreoathetoid 4 (7.01%) & mixed in 3 (5.29%). Seizures 27 (47.36%), aspiration pneumonia and bronchopneumonia 8 (14.03%) each were the commonest comorbidities associated. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia in 7 (31.8%) each. Other risk factors in decreasing order of frequency were, pregnancy induced hypertension (PIH) in mothers 5 (29.41%), multiple gestations 5 (29.41%), neonatal meningitis 4 (18.18%), hypothyroidism in mothers 3 (17.64%), toxoplasmosis 2 (1.76%), rubella 2 (11.76%), maternal diabetes mellitus 2 (3.5%), neonatal hyperbilirubinemia 3 (13.6%) and neonatal seizure in 1 (1.75%). MRI was abnormal in 49 (85.96%) patients with PVL in 22 (38.59%), cortical atrophy in 7 (12.22%), post HIE changes in 4 (7.01%),followed by basal ganglion lesions, lissencephaly, porencephalic cyst , schizencephaly cortical dysplasia, dilated ventricles and infarctions. Conclusions: The commonest type of CP was spastic diplegia 28 (49.1%), followed by spastic quadriplegia, spastic hemiplegia, choreoathetoid and mixed. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia, followed by Pregnancy Induced Hypertension (PIH) in mothers, multiple gestations, neonatal meningitis, hypothyroidism in mothers, toxoplasmosis, rubella, maternal diabetes mellitus, neonatal hyperbilirubinemia and neonatal seizure. Seizures, aspiration pneumonia and bronchopneumon were the commonest comorbidities associated. MRI was abnormal in 49 (85.96%) patients with PVL, cortical atrophy, post HIE changes being the most common changes followed by basal ganglion lesions, lissencephaly porencephalic cyst, schizencephaly, cortical dysplasia, dilated ventricles and infarctions.