title: Neonatal neuroimaging predicts recruitment of contralesional corticospinal tracts following perinatal brain injury.
abstract: OBJECTIVE
  Unilateral perinatal brain injury may result in recruitment of ipsilateral projections originating in the unaffected hemisphere and development of unilateral spastic cerebral palsy (USCP). The aim of this study was to assess the predictive value of neonatal neuroimaging following perinatal brain injury for recruitment of ipsilateral corticospinal tracts.
  
  
  METHODS
  Neonatal magnetic resonance imaging (MRI) and cranial ultrasound scans of 37 children (20 males, 17 females; median [range] gestational age 36 wks(+4) [26(+6) -42wks(+5) ] and birthweight 2312 g ([770-5230g]) with unilateral perinatal arterial ischaemic stroke (n=23) or periventricular haemorrhagic infarction (n=14) were reviewed and scored for involvement of the corticospinal trajectory. Hand function was assessed using the Assisting Hand Assessment (AHA) and transcranial magnetic stimulation (TMS) was performed (age range 7y 4mo-18y and 7mo) to determine the type of cortical motor organization (normal, mixed or ipsilateral). Neuroimaging scores were used to predict TMS patterns.
  
  
  RESULTS
  Eighteen children developed USCP with ipsilateral corticospinal tract projections in 13 children (eight mixed, five ipsilateral). AHA scores decreased with increased ipsilateral projections. Asymmetry of the corticospinal tracts seen on neonatal MRI was predictive of development of USCP and recruitment of ipsilateral tracts (positive and negative predictive value of 73% and 91%).
  
  
  CONCLUSIONS
  Neonatal neuroimaging can predict recruitment of ipsilateral corticospinal tracts. Early knowledge of the expected pattern of cortical motor organization will allow early identification of children eligible for early therapy.
authors: Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands. n.vanderaa@umcutrecht.nl
authors: Niek E
authors: NE
authors: van der Aa
authors: Cornelia H
authors: CH
authors: Verhage
authors: Floris
authors: F
authors: Groenendaal
authors: R Jeroen
authors: RJ
authors: Vermeulen
authors: Stella
authors: S
authors: de Bode
authors: Onno
authors: O
authors: van Nieuwenhuizen
authors: Linda S
authors: LS
authors: de Vries
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000293:injuries / Q000502:physiology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D002547:Cerebral Palsy / Q000209:etiology / Q000503:physiopathology*; D002648:Child; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000293:injuries / Q000502:physiology / Q000503:physiopathology; D059906:Neuroimaging / Q000379:methods*; D011237:Predictive Value of Tests; D011712:Pyramidal Tracts / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation; D014463:Ultrasonography