Evaluation of the relationship between etiology, pathology andclinical manifestations of children with cerebral palsy by using Tc-99m HMPAO brain perfusion SPECT

Key words: Children, cerebral palsy, SPECTPurpose: This study was performed to evaluate cerebral perfusion impairments in these patientsby using Technetium-99m-hexamethylpropyleneamine-oxine (Tc-99m HMPAO) brain single photonemission computed tomography (SPECT).Introduction: The cerebral palsy (CP) is a heterogeneous group of non-progressive motordisorders of the developing brain. CP is caused by a spectrum group of developmental, genetic,metabolic, ischemic, infectious and other acquired etiologies that produce a common group of neurulogicphenotypes. In addition although CP is often associated with epilepsy and abnormalities of speech, visionand intellect, it is the selective vulnerability of the brain?s motor systems that defines the disorder.Although it has historically been considered as a static encephalopathy, this term is now inaccuratebecause of the recognition that the neurologic features of CP often change or progress over time.Therefore, early diagnosis is very important. But conventional diagnostic techniques has often limitedvalue.Tc-99m HMPAO is widely used as an imaging tool evaluate regional cerebral blood flow .Methods: Fifty children with CP (34 boys, 16 girls; age range 1yr to 17 yr, median 8yr) werereviewed to study their clinical profiles, etiological factors and associated problems. The clinical subtypesof CP were dyskinetic (n=14), spastic quadriplegia (n=13), spastic hemiplegia (n=11), mixed (n=7) andspastic diplegia (n=5).Transaxial, coronal and sagittal images obtained with an brain-dedicated annular crystal gammacamera were qualitatively analyzed and compared with the findings of computed tomography (CT) andelectroencephalogram (EEG).Results: In SPECT, cerebellum hypoperfusion was seen in 42% (n=21) patients, followed byhypoperfusion in the parietal lobe (n=18,36%), frontal lobe (n=15,30%), temporal lobe (n=9,18%), basalganglia and thalamus (n=10,20%), occipital lobe (n=4,8%). SPECT was normal in 32% (n=16) patients. InSPECT, perfusion defects was seen in 54% (n=14) patients whom CT were normal (n=26) and in 82%(n=10) patients whom EEG were normal (n=12).Conclusion: SPECT revealed a functional decrease in cerebral perfusion prior to establishmentof structural change in brain. Therefore, brain SPECT was found as an useful imaging procedure in theearly diagnosis of cerebral palsy. Since the number of cases examind in this study was limited, itwas not possible to estabilish a significant relationship between parameters. Statistically significant resultsmaybe obtained after examining more cases.