Imaging cerebral palsy

Abstract

Neuroimaging in children with (suspected) cerebral palsy is useful for contributing to or corroborating the diagnosis, clarifying the etiology and the "timing" of the underlying brain lesion, establishing a prognosis and, in some cases, as a basis for genetic counseling. Therefore, each child with cerebral palsy should undergo at least one neuroimaging procedure. While cranial ultrasound is often the first and least invasive technique applied in newborns and infants, and computed tomography is beneficial especially in emergency situations, the "gold standard" technique for imaging children with cerebral palsy is magnetic resonance imaging, ideally performed after the age of 2 years. Underlying brain lesions can be subdivided into brain malformations (including disorders of neuronal proliferation and cellular lineage, disorders of neuroblast migration, and disorders of neocortical organization) and defective lesions. Defective lesions, which typically occur only during the 3rd trimester of pregnancy or peri-/postnatally, are subdivided into lesions affecting primarily the periventricular white matter ("early 3rd trimester lesions") and those affecting primarily structures of cortical/deep gray matter ("late 3rd trimester lesions"). The understanding of the functional consequences of such lesions can be enhanced by diffusion tensor tractography; cortical (re-)organization can be visualized using functional magnetic resonance imaging (fMRI).