Cerebral Palsy in Jordan: Clinical and Neuroimaging Characteristics

Objective: To evaluate the diagnostic findings of neuroimaging in patients with cerebral palsy and if there is any specific finding correlated to certain types of Cerebral Palsy.Methods: Case records of 158 patients diagnosed to have cerebral palsy attending the pediatric neurology and neurodevelopmental clinics at King Hussein Medical Center and King Abdullah University Hospital over 2 years period, 2006 and 2007, were studied retrospectively with reference to their clinical characteristics and their correlation to the neuroimaging (MRI and CT scan) findings.Results: A total of 158 cases with cerebral palsy were included in the study, 84 (53%) males, 74 (47%) females, 41 (26 %) preterm and 117 (74%) full- term babies. Spastic cerebral palsy was seen in 112(70.8%) with spastic quadriplegia being the commonest seen in 63(40%). Hypotonic ataxic type present in 22(14%), dyskinetic 15(9.4%) and mixed cerebral palsy in 9(5.6%). Abnormal neuroimaging findings were seen on MRI in 125(79%), while in CT scan in 113(71%). Specific neuroimaging findings were seen suggesting brain asphyxia in 40(25%), congenital brain anomaly in 22(14%), intracranial hemorrhage in 10(6%), vascular and infectious causes in 29(18.5%), unknown/isolated brain atrophy in 26(16.5%), and periventricular leukomalacia in 31(20%). The most common single etiology identified was birth asphyxia 40(25 %), and the second is periventricular leukomalacia which was identified in 31 patients (20%). Nonspecific brain atrophy was considered as nonspecific finding, that was found most often in patients with dyskinetic CP 5/15(33 %), and in patients with spastic quadriplegia 15/63(24 %) as compared to other groups.Conclusion: The principle contribution of imaging is to the understanding of etiology and pathogenesis, including ruling in or out conditions that may have implicated a genetic counseling, such as malformations. MRI is a more sensitive test than CT in detecting brain abnormalities.