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AJNR - American Journal of Neuroradiology

Publication Preview: Published October 29, 2009

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1854

PEDIATRICS

Anatomic Localization of Dyskinesia in Children with "Profound" Perinatal Hypoxic-Ischemic Injury

P.D. Griffiths, M.R. Radon, A.R. Crossman, D. Zurakowski and D.J. Connolly

From the Academic Unit of Radiology (P.D.G., M.R.R., D.J.C.), University of Sheffield, Sheffield, UK; Faculty of Life Sciences (A.R.C.), University of Manchester, Manchester, UK; and Departments of Anesthesia and Surgery (D.Z.), Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts.

Please address correspondence to Mark Radon, MD, Department of Radiology, Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, UK; e-mail: mark.radon{at}gmail.com

BACKGROUND AND PURPOSE: CP is a common feature of perinatal HIBD in the context of "acute profound" injury, and in this article, we have studied the possible anatomic substrates of dyskinesia. We have reviewed the extent of brain injury in children with dyskinetic and spastic CP due to acute profound hypoxia to identify sites of injury that explain why only some children develop movement disorders. It is known that the STN has a role in the development of movement disorders; therefore, we have specifically studied it.

MATERIALS AND METHODS: We retrospectively reviewed MR imaging of 40 consecutive children referred to our center with CP confirmed to be due to acute profound hypoxic-ischemic injury. All children received the same high-resolution MR imaging protocol with the same 1.5T scanner. Two pediatric neuroradiologists reviewed the imaging. Logistic regression was applied to identify multivariable predictors that differentiate dyskinetic and spastic CP.

RESULTS: Twenty children had dyskinetic CP and 20 had spastic CP. Children with dyskinetic CP had more frequent injury to the STN, as manifest by increased T2 signal intensity. Children with spastic CP had more severe damage to white matter in the vicinity of the paracentral lobule. Injuries to the putamen, caudate, and globus pallidus were not significant predictors of dyskinesia.

CONCLUSIONS: We have shown an association between hypoxic-ischemic injury to the STN at birth and the emergence of dyskinesia later in life.

Abbreviations: VA-VL, ventral anterior and ventral lateral nuclei of the thalamus