Cerebral palsy: risk factors, comorbidities and associated MRI findings, a hospital based observational study

Bilal Ahmad Najar, Aliya Kachroo, Imran Ahmad Gattoo, Sheikh Quyoom Hussain


Background: Cerebral palsy is a common pediatric disorder occurring in about 2-2.5/1000 live births. It is a chronic motor disorder resulting from a non-progressive static insult to the developing brain. There are various risk factors associated with it. Also it is accompanied with varied comorbidities and MRI findings depending on the etiology. Aims and objectives: To study the various risk factors, comorbidities and MRI findings in patients with cerebral palsy patients.

Methods: A hospital based observational study was undertaken in the post graduate department of pediatrics, GB pant hospital, GMC Srinagar, Northern India. The study was carried out over a period of one year from September, 2009 to August 2010. During this year 22036 patients were admitted in this hospital, of which 2077 (9.42%) were neurological cases. Of these 2077 neurological cases, 145 (6.98%) were cerebral palsy patients, however only 57 children were included in our study. Other 88 CP cases were excluded as they were not fulfilling the inclusion criteria. After thorough clinical history and examination relevant investigations were done including MRI brain.

Results: The commonest type of CP was spastic diplegia 28 (49.1%). Other types were spastic quadriplegia in 11 (19.29%), spastic hemiplegia 11 (19.29%), choreoathetoid 4 (7.01%) & mixed in 3 (5.29%). Seizures 27 (47.36%), aspiration pneumonia and bronchopneumonia 8 (14.03%) each were the commonest comorbidities associated. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia in 7 (31.8%) each. Other risk factors in decreasing order of frequency were, pregnancy induced hypertension (PIH) in mothers 5 (29.41%), multiple gestations 5 (29.41%), neonatal meningitis 4 (18.18%), hypothyroidism in mothers 3 (17.64%), toxoplasmosis 2 (1.76%), rubella 2 (11.76%), maternal diabetes mellitus 2 (3.5%), neonatal hyperbilirubinemia 3 (13.6%) and neonatal seizure in 1 (1.75%). MRI was abnormal in 49 (85.96%) patients with  PVL in  22 (38.59%), cortical atrophy in 7 (12.22%), post HIE changes in 4 (7.01%),followed by  basal ganglion lesions, lissencephaly, porencephalic cyst , schizencephaly cortical dysplasia,  dilated ventricles  and infarctions.

Conclusions: The commonest type of CP was spastic diplegia 28 (49.1%), followed by spastic quadriplegia, spastic hemiplegia, choreoathetoid and mixed. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia, followed by Pregnancy Induced Hypertension (PIH) in mothers, multiple gestations, neonatal meningitis, hypothyroidism in mothers, toxoplasmosis, rubella, maternal diabetes mellitus, neonatal hyperbilirubinemia and neonatal seizure. Seizures, aspiration pneumonia and bronchopneumon were the commonest comorbidities associated. MRI was abnormal in 49 (85.96%) patients with PVL, cortical atrophy, post HIE changes being the most common changes followed by basal ganglion lesions, lissencephaly porencephalic cyst, schizencephaly, cortical dysplasia, dilated ventricles and infarctions.


Cerebral palsy, Seizures, Periventricular Leukomalacia

Full Text:



Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Neurol. 1992 June;34(6):547-51.

William John Little. History of cerebral palsy. Little. 1861, 1862, Acearelo 1889, Osler 1887. Available at: http://cerebralpalsy.org/about-cerebral-palsy/history-and-origin/.

Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005 Aug;47(8):571-6.

Robert M. Kliegman, Bonita MD. Stanton, Joseph St. Geme, Nina F. Schor. Cerebral palsy. In: Robert M. Kliegman, Bonita MD. Stanton, Joseph St. Geme, Nina F. Schor, eds. Nelson Text Book of Pediatrics. 20th ed. US: Elsevier; 2015: 2494.

Rosen MG, Dickinson JC. The incidence of cerebral palsy. Am J Obstet Gynecol. 1992;167(2):417-23.

Pratiba D. Singhi. Cerebral palsy. In: Pratiba D. Singhi, eds. IAP Text Book of Paediatrics. 4th ed. New Delhi: Jaypee Brothers Medical Publishers; 2012: 1045.

Dolk H, Pattenden S, Johnson A. Cerebral palsy, lowbirth weight and socio economic deprivations: in equalities in a major cause of childhood disability. Paediatric Perinat Epidemiol. 2001 Oct;15(4)359-63.

Stanely F, Blair E, Alberman. Cerebral palsy: epidemiology and causal pathways. In: Stanely F, Blair E, Alberman, eds. A Book. 2nd ed. London: Mackeith Press; 2000.

Vincer MJ, Allen Ac Joseph KS, Stinson DA, Scott H, Wood E. Increasing prevalence of cerebral palsy among very preterm infants: a population based study. Paediatrics. 2006 Dec;118(6):1621-6.

Bushan V, Paneth N, Kiely J. Impact of improved Survival of very low birthed with infants of recent secular trends in the prevalence of cerebral palsy. Pedtratics. 1993;91:1094-100.

Pschirrer R, Yeomans E. Does asphyxia cause cerebral palsy? Semin Perinatol. 2000;24:215-20.

Stelmach T, Kallas E, Pisarev H, Talvik T. Antenatal risk factors associated with unfavourable neurological status in new-born and at 2 years of age. J Child Neurol. 2004;19(2):116-22.

Moster D, Wileox AJ, Vollset SE, Markestad T, Lie RT. Cerebral Palsy among term and post term births. JAMA. 2010 Sep;304(9):976-82.

A. Parthasarathy. IAP text book of paediatrics. In: A. Parthasarathy, eds. A Book. 5th ed. New Delhi: Jaypee Brothers Medical Publishers; 2013.

Uvebrant P. Hemiplegic cerebral palsy: aetoloty and outcome. Acta Pediatr Scand Suppl. 1988;345:1-100.

Cioni G, Sales B, Paolicellia PB, Petachi E, Scusa MF, Canapicchi R. MRI and clinical characteristics of children with hemiplegic cerebral palsy. Neuropediatrics. 1999;301:249-55.

Aksu F. Nature and progress of seizure in children with cerebral palsy. Dev Med Child Neurol. 1990;32:661-8.

Okumura A, Hayakawa F, Kato T, Kuno K, Watanabe K. Epilepsy in patients with spastic cerebral palsy. Correlation with MRI finding at 5 years of age. Brain Dev. 1999;21:540-3.

Kwong KL, Wong SN, Sok T. Epilepsy in children cerebral palsy. Pediatic Neurol. 1998;19:31-6.

Stevenson R, Robern C, Vogtel L. The effects of non-nutritional factors on growth in cerebral palsy. Dev Med Child Neurol. 1995;35:124-30.

Dorman J, Pellegrino L. Bladder dysfunction. In: Paul H, eds. Caring for Children with Cerebral Palsy. 1st ed. Baltimore MD: Brookes Publishing Co; 1998: 533.

Jan MMS. Melatonin for the treatment of Handicapped children with severe sleep disorder. Pediatr Neurol. 2000;123(3):229-32.

Siegel L, Klingbeil M. Control of drooling with transdermal scopolamine in child with cerebral palsy. Dev Med Child Neurol. 1991;331:1010-4.

Menaker S, Batshaw M. Hearing and visual abnormalities. In: Batshaw M, eds. Our Windows to the World. 2nd ed. Baltimore: Brooks; 1997: 211-240.

Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcome in preterm infants. N Engl J Med. 2006 Aug;355(7):685-94.

Kulak W, Saboneic W, Goscik M, Olenski J, Kurohska O, Zawada B. Clinical & neuroimaging profile of congenital malformations in children with spastic cerebral palsy. Adv Med Sci. 2008;53(1):42-8.

Yamada K, Itoh M, Fueki N, Hirasiva K, Suzuki N, Kurata K, et al. The cranial MRI in severe cerebral palsy: a comparative study with clinical data. No To Hattatsu. 1993;25(5):435-41.

Kwong KL, Wong YC, Fong CM, Wong SN, Sok T. Magnetic resonance imaging in 122 children with spastic cerebral palsy. Pediatr Neurol. 2004 Sep;31(3):172-6.

Robinson MN, Peake LJ, Ditchfield MR, Reid SM, Lanigan A, Reddihough DS. Magnetic resonance imaging findings in a population based cohort of children with cerebral palsy. Dev Med Child Neurol. 2009 Jan;51(1):3-4.

Wu Yw, Croen LA, Shah SJ, Newman TB, Najjar DV. Cerebral palsy in a term population: risk factors and neuroimaging finding. Paediatrics. 2006;118:690-7.

Sugimoto T, Woo M, Nishida M, Araki N, Hara T, Yasuharra A, et al. When do brain abnormalities in cerebral palsy occur? An MRI study. Dev Med Child Neurol. 1995;37:285-92.

Krageloh Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol. 2007 Oct;49(10):799-800.

Sagioya T, Yamaguchi K, Kuniyoshi K, Moromizato H, Ohgane T, Horikawa A. MR imaging of cerebral palsy. Nippon Igaku Hoshasen, Gakkai Zasshi 1996;56:490-495.

Gururaj A, Sztriha L, Dawodu A, Nath KR, Varady E, Nork M, et al. CT and MRI pattern of hypoxic ischemic brain damage following perinatal asphyxia. J Trop Pediatr. 2002;48:5-9.

Hou M, Fan XW, Li YT, Yu R, Guo HL. Magnetic resonance imaging findings in children with cerebral palsy. Zhonghhua Er Ke Za Zhi. 2004;42(2):125-8.