Dyskinetic cerebral palsy in term asphyxiated neonates – clinical features and brain magnetic resonance imaging

Abstract

Dyskinetic cerebral palsy is rare, occurring in about 14 per 100 000 live births and accounting for about 7% of all cerebral palsy cases, but represents one of the most disabling forms of cerebral palsy. Increasing use of magnetic resonance imaging off ers an opportunity to visualize brain lesions in cerebral palsy, which are in dyskinetic cerebral palsy typically caused by hypoxic lesions of the thalami, basal ganglia and parasagittal region and hippocampus in term asphyxiated neonates. Moreover, degrees of magnetic resonance imaging lesion patterns can be defi ned, which correlate with the severity of motor impairment and accompanying neurodevelopmental disorders. The aim of this study was to describe the profi le of motor disability and accompanying impairments in children with dyskinetic cerebral palsy in four term asphyxiated infants as well as their magnetic resonance imaging lesion patterns. All four term children had severe perinatal asphyxia according to data at birth, followed by moderate to severe hypoxic-ischemic encephalopathy in three of them. Subsequent magnetic resonance imaging showed hypoxic lesions of the thalami, basal ganglia and central regions or hippocampus, classifi ed as mild (Patients 2 and 4) or severe (Patients 1 and 3). Neurodevelopmental outcome was poor in three of the four children. Three of them had severe dyskinetic cerebral palsy of choreoathetoid subtype, whereas the fourth patient had less severe dyskinetic cerebral palsy. Accompanying impairments were in all four patients related to severe speech disturbance, epilepsy in Patients 1 and 4, while cognitive development was normal or mildly aff ected. The severity of dyskinetic cerebral palsy and accompanying disorders correlated with the severity of hypoxic lesions in the strategic domain, i.e. thalamus, n. lenticularis, central regions and hippocampus.