Understanding causation of cerebral palsy by using magnetic resonance imaging

Magnetic resonance imaging (MRI) plays an important role in elucidating aetiology, or at least pathogenesis of cerebral palsy (CP). When systematically analyzing studies using MRI in children with CP, MRI proves to be abnormal in around 85% of cases and gives a clear pathogenetic pattern in more than 80%. White matter lesions, predominantly in the periventricular area, are most frequent (more than 50%), followed by cortical and deep grey matter lesions (around 20%). Brain maldevelopments are rather rare, described in less than 10%. Brain maldevelopments and grey matter lesions are more often seen in term than in preterm children with CP (16% vs 2.5% and 33% vs 3.5%), whereas periventricular white matter lesions occur significantly more often in preterm than in term children (90% vs 20%). Thus, CP is mainly characterized by brain lesions which can be identified by MRI. This supports a mainly acquired, e.g. lesional origin in the majority of children. This is especially true for children with spastic and dyskinetic CP subtypes, which account for 94% of CP. Ataxic CP is different; abnormal MRI-findings are reported in less than 40% and in at least 50% of cases are clearly not lesional.