MRI in CP (MRI report in Cerebral Palsy):- by Nastursim

MRI in CP

My 17 monthold daughter has been suffering with hypotonia since birth and has beendiagnosed with mild cerebral palsy. Recently she had an MRI performedand the report is all gibberish to me, and I was wondering if someonecould help interpret it for me, in plain english and explain what is normally found on MRI in CP.

“Myelinationappears slightly delayed for the patient’s age withrelatively high signal in the region of the arcuate fibres in theoccipital lobes on FLAIR and T2 weighed imaging. The cerebral sulci andsylvian fissures appear slightly prominent consistent with relativereduction in white matter volume. The features are consistent withdelayed myelination, particularly posteriorly. The features arenonspecific and the differential diagnosis includes pervientricularleucomalacia”

What the heckdoes all this mean really, apart from being told she has mild CP andhypotonia it doesn’t give me any specific area of injury andwhat parts of her life it will affect. She doesn’t have goodposture and was slow to achieve her development goals, although she hasnow been walking for 5 weeks after extensive therapy. Her ring fingersand pinky’s do not have a lot of strength at all. What partsof development does the damage to the white matter affect, will shelose strength as she grows , what are we looking at? Could anyoneplease help?

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  • asktheneurologist

    Thanks Nastursim for your question regarding MRI in CP.

    Firstly, cerebral palsy (CP) by definition, does not getworse as the child gets older. Certain issues may become more obviousas your daughter develops, however a deterioration in function does notoccur due to CP.

    An answer to the question “What is whitematter?” may interest you and can be found here:-

    http://www.asktheneurologist.com/white-matter.html

    These white matter changes do not tell us much about whatto expect from the future. The best predictor of what will be in thefuture is observing how the child develops and performs on varioustests of their function.

    Regarding MRI in CP:-The MRI findings are often found in children born veryprematurely or with very low birth weights…was this the case?

    thanks,

    Clinical Guru 2

  • Nastursim

    Thank you for the reply. No, she was not premature at all,born at 39 weeks. It is thought that the damage may be related to a fluI had at about 25 weeks. I was induced as my waters broke 24 hoursprior to giving birth. She did suffer with jaundice afterwards andslept for, like unconscious, for the first month and lost more than athird of her birth weight in the first week. Could you please help totranslate the report into English for me, as I don’tunderstand exactly what it means

  • asktheneurologist

    Here is a “translation” into laymenterms as requested.
    Myelination (the process of adding a fatty insulating sheath around thenerve cells in the brain) appears slightly delayed for thepatient’s age .
    We know this because certain parts of the scan are whiter than theyshould be which in technical terms we describe as “relativelyhigh signal in the region of the arcuate fibres in the occipital lobeson FLAIR and T2 weighed imaging.
    The cerebral sulci (the little valleys between bumps on the brainsurface) and sylvian fissures (the big valleys on each side of thebrain surface) appear slightly prominent (are deeper and or wider thanthey should be) consistent with relative reduction in white matter volume .
    The features are consistent with delayed myelination (the process ofadding a fatty insulating sheath around the nerve cells in the brain),particularly posteriorly (at the back of the brain). The features arenonspecific and the differential diagnosis (possible cause) includespervientricular leucomalacia (a disorder of the white matter around thefluid-filled areas of the brain know as ventricles).

    Hope this helps

    Clinical Guru 2

  • nastursim

    thank you for that.
    Apparently there is damage to the white matter on both sides of thebrain, and she also has a diagnosis of mild CP. Is this possible, Ithought CP was an injury to a specific part of the brain, where as thisseems to be the nerve fibres. I am just a little confused by all this.Her posture is poor, and her muscle tone is weak, is this a sign andsymptom of on or both? I have also read there can be visual problemslater on, when would this become evident? Is there any more info youcould give me??

  • asktheneurologist

    CP is basically any brain damage occurring before oraround the time of birth and which does not get worse throughoutlife…CP can affect different people in different waysdepending on the part of the brain which is affected. If there are novisual problems now then there will certainly not be any worsening ofher vision due to CP.

    Hope that helps

    Clinical Guru 2



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