Cerebral palsy and associated neurodevelopmental impairments in children with cortical dysgenesis

Autor: Ivana Đaković, Andrea Šimić Klarić, Vlatka Mejaški Bošnjak, Želimir Šimić, Zdravko Kolundžić, Nikola Gotovac
Rok vydání: 2014
Předmět:
Zdroj: Paediatria Croatica
Volume 58
Issue 4
ISSN: 1330-1403
1846-405X
Popis: Kortikalna disgeneza je spektar anomalija mozga uključenih u poremećaj razvoja moždane kore, nastao zbog poremećaja migracije neurona. Prikazujemo dva dječaka s cerebralnom paralizom i pridruženim neurorazvojnim odstupanjima zbog kortikalne disgeneze. Prvi bolesnik je petogodišnji dječak u kojeg je u dobi od šest mjeseci zamijećen ljevostrani hemiparetski razvoj. U elektroencefalogramu (EEG) uočeno je žarište desno centro-temporalno, a na magnetskoj rezonanciji (MRI) mozga vidljiva je anomalija razvoja moždane kore u smislu operkulum sindroma desno. Provodi se fi zikalna terapija te zbog artikulacijskih poteškoća i logoterapija. Dosad nije imao konvulzije. Drugi bolesnik je dječak koji od dojenačke dobi ima ljevostrani hemiparetski razvoj. Rođen je u 33. tjednu gestacije, a imao je i perinatalnu infekciju. Zbog povišenog IgG-a na citomegalovirus, obavljen je PCR u urinu i serumu koji je bio pozitivan, ali bez indikacija za terapiju ganciklovirom. U dobi od tri godine dječak pokazuje jednostrani spastični obrazac cerebralne paralize lijevo. U EEG-u se registriraju šiljci preko desne hemisfere s tendencijom sekundarnoj generalizaciji. Na MR-u mozga vidljiv je poremećaj migracije neurona u smislu pahigirije obostrano. Kod dječaka se provode vježbe medicinske gimnastike, radna terapija te zbog usporenog govorno-jezičnog razvoja i logoterapija. Dosad nije imao konvulzije, a nalaz EEG-a je nepromijenjen. Neurorazvojni ishod naših bolesnika s kortikalnom disgenezom obilježavaju cerebralna paraliza s pridruženim neurorazvojnim odstupanjima, poremećajem jezičnog razvoja te rizikom za pojavu epilepsije (žarišno promijenjen EEG). Kortikalnu disgenezu je moguće prikazati samo MRI-om mozga, a treba je uzeti u obzir kao mogući uzrok cerebralne paralize.
Cortical dysgenesis is included in the spectrum of developmental brain anomalies due to neuronal migration disorder. This paper presents the cases of two boys with cerebral palsy and associated neurodevelopmental impairments due to cortical dysgenesis. The fi rst patient is a boy at the age of 5 years who was diagnosed with left-sided hemiparesis. Electroencephalogram showed focal rightsided centrotemporal spikes, and magnetic resonance of the brain displayed cerebral cortex malformation consistent with opercular syndrome of the right hemisphere. The child is included in physiotherapy and, due to articulation impairments, speech and language therapy. Until now, he has not experienced seizures. The other patient has developed left-sided hemiparesis since infancy. He was born in the 33rd week of gestation and had perinatal infection. Serum level of cytomegalovirus (CMV) IgG and polymerase chain reaction in urine and serum were positive, but ganciclovir therapy was not indicated. At the age of 3 years, the boy developed unilateral spastic cerebral palsy. Electroencephalogram showed spikes over the right hemisphere with a tendency to generalize. Magnetic resonance of the brain showed neuronal migration disorder in terms of bilateral pachygyria. The boy is involved in physiotherapy, occupational therapy and speech and language therapy due to delayed speech development. Seizures have not occurred to date. Electroencephalographic discharges are still present. In conclusion, neurodevelopmental outcomes of our patients with cortical dysgenesis are marked with cerebral palsy with associated neurodevelopmental impairments, speech and language disorders, and a risk of developing epilepsy due to abnormal electroencephalogram. We conclude that cortical dysgenesis should be taken in consideration as a possible cause of cerebral palsy. Correct visualization may be obtained by magnetic resonance imaging of the brain.
Databáze: OpenAIRE
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