Regional cerebral blood perfusion in children with hemiplegia: A SPECT study.

Fourteen children with spastic hemiplegia of various etiology: cerebral palsy (seven cases, five with porencephalic cyst); stroke with small deep infarcts (two); hemiconvulsion-hemiplegia-epilepsy syndrome (three); traumatic brain injury (two), were investigated by 99mTc-HMPAO SPECT. Localized and remote perfusion abnormalities were studied. Hypoperfusion corresponding to CT abnormalities was found in each group, but the perfusion deficit extended beyond the boundaries of anatomical defects, most prominently in cases with widespread unilateral epileptic discharges. Ipsilateral cerebellar diaschisis was observed in patients with early cerebral insult (who had porencephalic cyst of pre- or perinatal onset) and crossed cerebellar diaschisis was noted in a patient who sustained traumatic brain injury at a later age. Diaschisis in the overlying cortex, thalamus and basal ganglia was noticed in several cases. Although clinical symptoms or signs could not be unequivocally attributed either to the size of the perfusion defects beyond the boundaries of lesions shown by CT or to the diaschisis, the findings may contribute to reveal age-related abnormal perfusion patterns.