Late remission of congenital hemiparesis: the value of MRI.
In our department of neuropediatrics we made a definite diagnosis of congenital hemiparesis in a total of 123 patients born between 1974 and 1985. This diagnosis was always made or confirmed at a point after the patient's first birthday. Recently, we were able to follow up on 102 of them (83%) to determine whether their symptoms persist, that is, if the initial diagnosis of cerebral palsy (CP) was correct or not. Now, at the age of 9 to 18 years, 94 of these 102 patients (92%) still suffer from hemiparesis. We were able to perform MRI on 44 of them. A lesion consistent with the neurological symptoms was found in 43. Only one patient had normal findings-a false negative, so to speak. Of the 102 patients, eight (8%) had no hemiparesis, i.e. no disability at all at the time of the follow-up. All eight had in common the fact that the former functional involvement had been slight and not arm-dominated. Seven of them were also examined with MRI. Six had normal findings; MRI revealed a periventricular lesion consistent with the earlier hemiparetic symptoms in only one patient (a false positive, so to speak). We conclude that some children "outgrow" a hemiparetic cerebral palsy, even in later childhood years. In our patient group this happened between the ages of 3 and 10. We further propose that MRI could be useful in distinguishing between transitory and persistent hemiparesis.
Department of Child Neurology, University Hospital of Tübingen, Germany.
G
G
Niemann
W
W
Grodd
M
M
Schöning
D002547:Cerebral Palsy / Q000151:congenital* / Q000175:diagnosis*; D015331:Cohort Studies; D005121:Extremities / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006429:Hemiplegia / Q000151:congenital* / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012075:Remission, Spontaneous; D012720:Severity of Illness Index