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Vol 11 No 1 January 2021

18

Original Article

Computed Tomographic Findings in Children with Cerebral Palsy in a 
Developing Country

Roushan Jahan1, Md. Mizanur Rahman2, Kanij Fatema3, Md. Enayet Karim4, Subrata Roy5
Received: 13 January 2020    Accepted: 25 August 2020

doi: https://doi.org/10.3329/jemc.v11i1.63169

Abstract

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood 
disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an 
important modality of investigation. Objective: This study was done to observe the findings in CT 
scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive 
study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were 
enrolled in the study. After selection of the subjects, demographic and clinical characteristics 
were recorded. All other comorbidities including visual and hearing impairments were identified. 
CT scan of brain was done in all children and reporting had been done by a single qualified 
radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). 
Seven types of CP were found in the study group. Among them quadriplegic CP were the most 
common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay 
was found in 90% children, speech delay was found in 88.2% children, visual impairment was 
found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% 
among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), 
followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). 
Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study 
showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT 
scan findings. Most common CT scan finding was cerebral atrophy. 

Key words: Cerebral palsy; Computed tomography; Encephalomalacia

       J Enam Med Col 2021; 11(1): 18−23

1. Consultant, General Hospital, Narayanganj
2.  Professor, Department of Pediatric Neurology, BSMMU
3.  Associate Professor, Department of Pediatric Neurology, BSMMU 
4.  Professor, Department of Radiology and Imaging, BSMMU, Dhaka
5.  Senior consultant (Pediatrics), National Institute of Kidney Diseases and Urology, Dhaka
Correspondence Kanij Fatema, Email: mailmonami@gmail.com

Introduction

Cerebral palsy (CP) describes a group of permanent 
disorders of the development of movement and 
posture, causing activity limitation, that are attributed 
to non-progressive disturbances that occurred in the 
developing fetal or infant brain.1 The motor disorders of 

cerebral palsy are often accompanied by disturbances 
of sensation, perception, cognition, communication 
and behavior by epilepsy and by secondary 
musculoskeletal problems.2-4 It is one of the most 
common causes of chronic childhood disability.5 The 



January 2021J Enam Med Col Vol 11 No 1

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prevalence of CP in the world is about 2−2.5/1000 live 
births.6-8 In the developed world the prevalence of CP 
remains very stable for many years at this percentage.3  
In Bangladesh the prevalence is about 6.1/1000 live 
births.9,10 CP is known to be associated with a host of 
proven etiologic factors. Prenatal causes are maternal 
hyperthyroidism, intrauterine infections, malnutrition 
etc. Perinatal causes are prematurity, VLBW, birth 
asphyxia, brain malformation, intrauterine growth 
retardation, hypoglycemia, dyselectrolytemias, 
sepsis, being a twin, TORCH infections, kernicterus 
etc. Postnatal risk factors are meningitis, encephalitis, 
head injury, seizures etc.11-13 Different etiologies 
occurring at different developmental stages can 
result in the same clinical pattern of cerebral palsy.14  
Alternatively, a similar etiology may produce variable 
outcomes.15 The American Academy of Neurology, in 
2004, published a practice parameter that advocated 
for the first time the routine neuroimaging of children 
with suspected cerebral palsy.15,16 A practice parameter 
regarding the value and indications for obtaining 
neuroimaging in preterm and term infants has recently 
been published.6 The current parameter addresses the 
role of neuroimaging in the infant or child who has 
been diagnosed with or is suspected of having CP 
based upon a motor deficit.6,17

Materials and Methods
This cross sectional descriptive study has been carried 
out in the Department of Paediatric Neurology and 
Institute of Paediatric Neurodisorder and Autism 
(IPNA), Bangabandhu Sheikh Mujib Medical 
University (BSMMU), Dhaka over a period of 1 
year and 6 months from March 2016 to August 2017. 
Purposive sampling was done and sample size was 
calculated. Total 200 CP patients had done CT scan 
of brain, among them 90 patients were excluded, 
because 30 patients had neurometabolic disease, 20 
patients had neurodegenerative disease, 25 cases 
did not give consent, 15 patients were < 1 year old. 
Patients were eligible if they had chronological age 
1to18 years. Child clinically diagnosed as a case 
of cerebral palsy and CT scan of brain was done 
following standard method as practiced in different 
centers but was reported by a single expert radiologist 
from the department of Radiology and Imaging at 
BSMMU. Informed written consent was taken from 

the parents. Demographic and clinical characteristics 
were recorded, physical examination (mainly detailed 
neurological examination) was done to identify the 
type of CP and associated co-morbid conditions. 
The psychologists of pediatric neurology unit did 
the psychological tests by using appropriate tools. 
Cognitive level was designated as normal or impaired 
with cut-off IQ of 70.  All the children had a formal 
visual and hearing assessment. Brainstem Auditory-
Evoked Responses/Auditory Brainstem Responses 
(BAER/ABR) or Otoacoustic Emissions (OAEs) test 
were done to assess hearing. CT scan was done by 64 
slice spiral CT machine.  

Results
Out of 110 patients with CP 69 (62.7%) were male 
and 41 (37.3%) were female. Most of them (77, 
70.0%) were socioeconomically poor. Most of the 
patients (67, 60.9%) lived in rural areas. Table I shows 
the demographic and socioeconomic characteristics of 
children with cerebral palsy   

Table I: Demographic and socioeconomic 
characteristics of children with cerebral 
palsy   (N=110)

Demographic variables Frequency Percentage
Age 
1−5 years
5−12 years
12−18 years

99
10
1

90.0
9.1
0.9

Sex 
Male
Female

69
41

62.7
37.3

Place of birth
Rural
Urban

67
43

60.9
39.1

Socioeconomic 
condition
Poor
Middle class
Rich

77
33
0

70.0
30.0
0.0

Birth order of the 
child 
First born
Second child
Third or later born
Twin                                                       

75
28
7
8

68.1
25.5
6.4
7.3



January 2021J Enam Med Col Vol 11 No 1

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Seven types of CP were found in the study group 
(Fig 1). Among them, quadriplegic CP were the most 
common (39.1%), followed by cases of hemiplegic 
CP (28.2%) and mixed type was 16.4%. Most of the 
patients (77.27%) were born at term.

Table II shows the distribution of the findings of CT 
scan of brain (N=110). Some patients had multiple 
findings.

Fig 1. Bar diagram showing the types of cerebral 
palsy (N=110)

Fig 2. Bar diagram showing the gestational age at 
birth (N=110)

Fig 4. Bar diagram showing the frequency of 
associated co-morbidities (N= 110)

Fig 3. Bar diagram showing the extent of perinatal 
problems (N=110)

This study found most of the patients had perinatal 
asphyxia (81.8%). Most of the patients had cognitive 
delay (90.9%), 2nd most common finding was speech 
delay (88.2%), seizure was present among 49 patients 
(44.4%).

Table II: Distribution of patients accroding to the 
findings of CT scan of brain (N=110)

CT scan findings Number Percentage

Brain atrophy (Fig 5) 69 62.7

Encephalomalacia (Fig 6) 17 15.5

Brian malformation (Fig 
7, 8, 9) 13 11.8

Periventricular Leukoma-
lacia (PVL) 2 1.8

Calcification due to 
TORCH infection 15 13.6

Delayed myelination 1 0.9

Focal arterial infarction 1 0.9

Normal 13 11.8



January 2021J Enam Med Col Vol 11 No 1

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Discussion

Computerized tomography is a useful tool for 
demonstrating the anatomical lesions responsible for 
CP patient’s clinical findings, useful in predicting 
prognosis and functional outcomes and to diagnose 
lesions which are correctable by neurosurgery.18−20 
In Bangladesh perspective, mostly CT scan of brain 
is done as MRI of brain is costly and needs general 
anesthesia. According to several literatures CT scan is 
considered to be a proven useful method of correlating 
morphology with clinical features in CP.21−23 Kolawole 
et al21 reported that 72.5% of children with cerebral 
palsy had positive CT scan findings while Taudorf 
et al23 found that 67% of children with CP had 
pathological CT scan findings.  In this study it was 

Fig 9. CT scan of brain showing porencephalic cyst 
in left fronto-parietal region

Fig 5.  CT scan of brain showing moderate generalized 
cerebral atrophy

Fig 6. CT scan of brain showing diffuse cerebral 
atrophy with encephalomalatic change and 
mild subdural collection

Fig 7. CT scan of brain showing Dandy Walker 
Malformation with hydrocephalus

Fig 8. CT scan of brain showing Arachnoid cyst



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found that 88.18% of children with CP had abnormal 
CT scan findings, most frequent (62.7%) pathological 
CT finding was cerebral atrophy which was similar 
to Moifo et al24, Taudorf et al23 and Kolawole et al21 
studies. Moifo et al24 found atrophy in 52.7% cases, 
Kolawole et al21 found atrophy in 30.8% cases and 
Taudorf et al23 found presence of brain atrophy in 44 
children among 56 pathological CT scan findings. 
Again in this study it was found that 2nd most common 
finding was encephalomalacia which was present 
in 15.5% cases followed by calcification due to 
infections (13.6%) and brain malformations were in 
11.8% of children with CP. Brain malformations found 
in this study were hydrocephalus with Dandy Walker 
malformation (1 children with CP), corpus callosal 
agenesis (3 children with CP), cortical dysplasia and 
arachnoid cyst in left temporo-paraetal regions (1 
children with CP), poor myelination (1 children with 
CP), Giant cisterna magna (2 children with CP), open 
lip schizencephaly with corpus callosal agenesis (1 
children with CP), porencephaly (2 children with CP), 
holoporencephaly with hypoplastic cerebellar vernis 
and posterior fossa cyst (1children with CP), cortical 
dysplasia (1children with CP). Korzeniewski15 also 
found about 10% of children with cerebral palsy 
was attributable to brain malformations. Martin , 
Clare  & Olof  found in their study there was 9.1% 
of children with CP had brain malformation.17 Moifo  
et al24 was also found brain malformations in 7.4% 
of children with CP. Multiple findings in CT scan of 
brain is common in children with CP. In this study 
it was found that significant number of studied 
population (26) had  two/more findings at a time 
which included-atrophy with calcification (3), atrophy 
with encephalomalacia (7), atrophy with infarct (4), 
atrophy with encephalomalacia with calcification (2), 
hydrocephalus with encephalomalacia (2), atrophy 
with calcification with subdural hematoma (1), 
atrophy with calcification with infarct (2), atrophy 
with encephalomalacia with subdural hematoma 
(1), atrophy with malformation (1), atrophy with 
encephalopathy (1), atrophy with calcification with 
malformation (1) and infective encephalopathy (1). 
Encephalomalacia was found in 15.5% of children 
with CP, calcification was found in 13.6% of children 
with CP and periventricular leukomalacia was found 

in 1.8% of children with CP. Taudorf et al23 found 
the frequency of pathological CT findings increased 
with increasing severity of the motor handicap. There 
were significantly more children with pathological CT 
findings among CP children suffering from epilepsy 
than among CP children without epilepsy. This study 
had also same results. Most of the children who had 
pathological CT findings suffered from epilepsy 
and had other co-morbid conditions like cognitive 
disorder, visual, hearing impairment, and feeding 
difficulty. 

This study showed that most common types of CP 
were quadriplegic CP and hemiplegic CP.  A significant 
number of patients had mixed type CP. In this study 
88.2% children with CP showed abnormality in 
CT scan. Most common findings of this study were 
cerebral atrophy followed by encephalomalacia, 
calcifications and brain malformation. Epilepsy and 
other co-morbid conditions were found in many 
children with abnormal CT scan findings, but no 
relation was investigated.

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