All issues > Volume 38(4); 1995

Original Article

J Korean Pediatr Soc. 1995;38(4):445-460. Published online April 15, 1995.

Neonatal Neurosonographic Findings, Cerebral Doppler and Electrophysiological Findings in Infants with Motor Idsturbance

Jae Kwang JK Kim¹, Kook In KI Park¹, Chang Il CI Park², Min Soo MS Park¹, Moon Sung MS Park¹, Ran R Namgung¹, Chul C Lee¹, Dong Kwan DK Han¹

¹Department of Pediatrics, Yonsie University College of Medicine, Seoul, Korea
²Department of Rehabilitation Medicine, Yonsie University College of Medicine, Seoul, Korea

Abstract

Purpose
: Neurosonography, cerebral doppler and electrophysiological study are valuable in predicting neurodevelopmental outcome. The purpose of this study was to analyze characteristics of neonatal neurosonographic findigs, cerebral doppler and electrophysiological findings in infants withmotor disturbance.
Methods
: The subjects were 33 infants hospitalized at Yonsei Severance Medical Center NICU from January, 1990 to December, 1992. 19 of these patients underwent neonatal cranial ultrasonogram and cerebral doppler and were diagnosed with cerebral palsy(CP) after Vojta treatment. 14 patients alose received Vojta treatment after discharge but showed only delayed development(DD). The cases were studied retrospectively and color doppler sonograpy was performed within 3 days of birth, 5-7 days after birth and weekly thereafter, and the cerebral blood flow velocity of the anterior cerebral artery was measured and comparison between normal pre-term and full-term infants done. Electroencephalogeraphy(EEG) and brainstem auditory evoked potential(BSAEP) were performed before discharge, with follow-up studies done only in cases showing abnormal findings, whereas visual evoked potential(VEP) was performed after discharge.
Results
: 1) Among the [atients diagnosed with CP or DD, 9 cases (47%) and 5 cases(36%) respectively were full-term infants and 5 cases(26%) and 4 cases(29%) were premature infants less than 31 weeks. 9 cases(58%) of CP patients showed normal birth weight. There were 4 cases(21%) of very low birth weight infants in the CP group and 5 cases(36%) in the DD group. 2) Antenatal brain damage was present 6 cases of CP(32%) and 6 cases of DD(43%). 5 fo the CP patients and 4 of the DD partients were had normal birth weight, indicating that motor disturbance in normal weight newborn is frequentli caused by antenatal brain damage. 3) Ventriculomegaly(VM) was demonstrated by neurosonography in 16 cases(84%) of CP patients and 12 cases(86%) of DD patients. Among the CP group, 6 cases showed more than moderate degree of VM, whereas in all cases of DD patients, mild VM was present, with the dgree of motor disturbance correlating with severity of VM. But the symmetricity of VM, frequency of intraventricular hemorrahage with VM was the same in both groups. Intraventricular hemorrhage was seen in 7 cases (37%) of CP group, and 9 cases(64%) of DDroup. Severe intraventricular hemorrahage was seen only in CP patients(5 cases) demonstrating that severe intraventricular hemorrhage causes neurologic sequelae. There was no difference in the frenqueny, severity or duration of perventricular echodensity(PVE) among the 2 groups. Parenchymal cystic formation was seen in 8 cases(42%) of CP patients and 3 cases of DD patients, the incidence (PVL) was present, DD was in 3 cases if the PVL was located in the frontoparietal lobe, whereas CP occurred if the PVL was situated in the parietal or occipital lobe(2 cases). There was a total of 4 cases of PVL, all diagnosed with CP, and those patients showing diffuse parenchymal cystic formation were also diagnosed as CP. Widening of interhemispheric fissure was seen in 7 cases of CP and 1 cases of DD, showing a singnificatn frequency in CP, whereas there was no difference in the linear echogenecity of the basal ganglia. 4) Abnormal EEG was seen in 12 cases(63%) of CP group and 4 cses(29%) of DD group. The follow up EEG was normalized in all DD patients but CP patients conhtinues to show significant EEG abnormalities (7 cases out of 9). BSAEP and VEP abnormalities showed no significant difference between the 2 groups. 5) There was no significant difference in the average resistance index(RI) which was calculated from the cerebral blood flow velocity measured by cerebral doppler among normal newborns, CP and DD patents group. But average RI of CP patients was significantly lower than that of normal newborns, indicating an increase in cerebral blood flow in early life with severe neurologic sequelae.
Conclusion
: Neurosogography, cerebral doppler and electrophysiological studies performed in the perinatal period of children with motor disturbance show characteristic abnormal finding, with significant differences among childrem diagnosed with CP and DDD.

Keywords :Motor disturbance, Cerebral Pasly, Delayed development, Cranial ultrasonogram, Cerebral dopper, EEG, BSAEP, VEP