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Research ArticlePediatric Neuroimaging

Anatomic Localization of Dyskinesia in Children with “Profound” Perinatal Hypoxic-Ischemic Injury

P.D. Griffiths, M.R. Radon, A.R. Crossman, D. Zurakowski and D.J. Connolly
American Journal of Neuroradiology March 2010, 31 (3) 436-441; DOI: https://doi.org/10.3174/ajnr.A1854
P.D. Griffiths
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M.R. Radon
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A.R. Crossman
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D. Zurakowski
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D.J. Connolly
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    Fig 1.

    Location of the STN. The normal STN is not seen on T2-weighted images at 1.5T because of its small size and signal-intensity characteristics close to the surrounding white matter structures. This coronal T2-weighted image from a child with dyskinetic CP arising from hypoxic-ischemic injury shows the STNs (arrows) as regions of high signal intensity because of gliosis within the nuclei.

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    Fig 2.

    Typical appearances of HIBD changes in a child with spastic CP following acute profound HIBD. A and B, Axial T2 images show moderate PCWM signal-intensity abnormality and very mild involvement of the putamen and thalamus. C, Coronal T2 image shows no signal-intensity abnormality in the region of the STN.

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    Fig 3.

    Typical appearances of HIBD changes in a child with dyskinetic CP following acute profound HIBD. A and B, Axial T2 images show mild involvement of the putamen, thalamus, and PCWM. C, Coronal T2 image shows high signal intensity in the region of the STN.

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    Fig 4.

    Line diagram shows the direct and indirect pathways from the putamen to the thalamus and hence to the motor cortex. Dashed lines indicate the neurons of the indirect pathway traveling via the STN (drawn based on data in Crossman12).

Tables

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    Table 1:

    Comparison of dyskinetic and spastic CP groupsa

    VariableDyskinetic CP (n = 20)Spastic CP (n = 20)P Value
    Age at time of MR imaging (yr)4.8 ± 3.76.0 ± 3.9.35
    Gestational age (wk)40.0 ± 1.339.1 ± 2.0.12
    Birth weight (kg)3.3 ± 0.53.3 ± 0.6.78
    Apgar score (5-minute)3 (1–7)4 (0–6).27
    Cord blood pH at birth6.92 ± 0.156.83 ± 0.20.18
    Head circumference (percentile)53.5 ± 26.035.4 ± 20.5.02b
    Age at onset of seizures (hr)3 (1–14)3.5 (1–18).17
    Putaminal injury score (0–3)
        Left2 (1–3)1.5 (0–3).72
        Right1 (0–2)1 (0–3).78
    Thalamic injury score (0–3)
        Left1 (1–3)1.5 (0–3).84
        Right1 (1–3)1 (0–3).64
    PCWM severity score (0–3)
        Left1 (0–2)2 (1–3).01b
        Right1 (0–2)2 (0–3.07
    Total injury score (0–18)8.0 (4–14)9.5 (4–18).38
    STN injury (No.) (%)15 (75)6 (30).01b
    Caudate injury (No.) (%)2 (10)8 (40).06
    GP injury (No.) (%)2 (10)6 (30).24
    • a Groups were compared by the Student t-test. All scores and age at onset of seizures are expressed as medians with ranges in parentheses and are compared by the Wilcoxon rank-sum test. The proportion of patients in each group with STN, caudate, and GP injuries was evaluated by the Fisher exact test.

    • b Statistically significant, P < .05.

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    Table 2:

    Results of multivariable stepwise logistic regression analysis

    Predictor VariableLRTP ValueOdds Ratioa95% CI
    PCWM left (0–3)8.2.0040.20.1–0.7
    STN injury11.1.00118.62.4–141.0
    Head circumferenceb6.7.0103.01.2–7.3
    • a Odds ratios and 95% CIs are with respect to dyskinetic CP and can be reciprocated to estimate the odds of spastic CP. Cox and Snell model R2 = 63%, indicating good fit to the data.

    • b Based on percentiles (10th, 25th, 50th, 75th, 90th) for head circumference with the 10th as the reference category.

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    Table 3:

    Multivariable algorithm for differentiating dyskinetic and spastic CPa

    HC (percentile)STN InjuryNo STN Injury
    PCWM Injury Score, LeftPCWM Injury Score, Left
    01230123
    10th9370308401121
    25th97875519662662
    50th989578508551164
    75th999890669475359
    90th9999978598906223
    • a Values represent percentage probabilities of dyskinetic CP according to the combination of the 3 predictors in the logistic regression model. Children with dyskinetic CP have a larger HC, more commonly have STN injury compared with those with spastic CP, and have lower left-sided PCWM scores. The probability of spastic CP can be determined by taking 100 minus the value in the table.

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American Journal of Neuroradiology: 31 (3)
American Journal of Neuroradiology
Vol. 31, Issue 3
1 Mar 2010
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Anatomic Localization of Dyskinesia in Children with “Profound” Perinatal Hypoxic-Ischemic Injury
P.D. Griffiths, M.R. Radon, A.R. Crossman, D. Zurakowski, D.J. Connolly
American Journal of Neuroradiology Mar 2010, 31 (3) 436-441; DOI: 10.3174/ajnr.A1854
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P.D. Griffiths, M.R. Radon, A.R. Crossman, D. Zurakowski, D.J. Connolly
Anatomic Localization of Dyskinesia in Children with “Profound” Perinatal Hypoxic-Ischemic Injury
American Journal of Neuroradiology Mar 2010, 31 (3) 436-441; DOI: 10.3174/ajnr.A1854

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