Serebral palsili hastalarımızın etiyolojik, klinik, demografik ve laboratuvar bulgularının değerlendirilmesi
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Date
2012
Authors
Sincar, Şahin
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada serebral palsili vakalarda etiyoloji ve prognozun değerlendirilmesi ve klinik bulguların incelenmesi amaçlandı.Çocuk nöroloji polikliniğinde serebral palsi tanısı ile takip edilen ve polikliniğe bavuran hastaların, fizik ve nörolojik muayeneleri yapıldı, anamnezleri alındı. Çalışma döneminde hastaneye başvurmayan hastaların ise dosyaları retrospektif olarak incelendi.Bu çalışmada, %63,5'i erkek ,%36,5'i kız çocuğu olmak üzere 520 vaka dahil edildi. Çalışmaya dahil edilen SP li hastaların incelendiği diğer çalışmalarla benzer şekilde; hastaların %71,9'u matür, %25,4'ü prematüre, %2,7'i si ise postmatür, hastaların erkek/kız oranı 1,73, %53,8 spastik tetraparezi, %17,7 spastik diparezi, %16,9 spastik hemiparezi, %8,7 diskinetik , %1,2 ataksik, %1,7 hipotonik olarak saptandı. Risk faktörleri prenatal, perinatal ve postnatal döneme ait olmalarına göre üç grup altında toplandı. Hipoksik-iskemik ensefalopati %36,9 oranıyla en sık görülen risk faktörü, İkinci olarak düşük doğum ağırlığı %35,3 ve üçüncü olarak nulliparite %34,6 oranında saptandı. Gelişmekte olan ülkelerdeki çalışmalarla benzer şekilde prenatal ve perinatal risk faktörlerinin SP gelişiminden sorumlu olan başlıca risk faktörleri olduğu saptandı. Vakaların %80,2' sinin kraniyal manyetik rezonans görüntüleme sonuçlarında patolojik bulgulara rastlandı. Prematüre vakalarda en sık tespit edilen patolojiler PVL %41,2 lokal enfarkt %10,6, bazal ganglion-talamus hasarı %6,9, yaygın atrofi %25,8 ve ensefalomalazi %5 bulundu. Matür vakalarda en sık tespit edilen patolojiler ise sınır PVL%16,2, lokal enfarkt %12,3, ensefalomalazi %9,8, yaygın serebral atrofi %21,3, bazal ganglia talamus hasarı %8,3 bulundu. Diğer çalışmalarla benzer şekilde kemik mineral yoğunluğu %40,8 vakada z skoru -2 nin altında tespit edildi. Çalışmamızda görsel uyarı potansiyelleri (VEP) testinde vakaların %61,3 sinde, beyin sapı işitsel uyarı potansiyelleri (BERA) testinde vakaların %52,7'sinde ileti yavaşlaması tespit edildi. Hastaların %29,6'sına epilepsinin eşlik ettiği ve en fazla saptanan EEG patolojisinin %41,7 ile fokal epileptiform anomali olduğu saptandı.SP halen Türkiye'de önemli bir mortalite ve morbidite nedenidir. Doğumhane şartlarının ve doğum ekibi standartlarının iyileştirilmesi, perinatal etiyolojik faktörlerin azaltılması, gebelerin iyi izlenmesi ve doğum sonrası takibin hastane şartlarında yapılmasının sağlanması ile SP sıklığının azaltılabileceğini düşünmekteyiz.
The Evaluation of Etiological, Clinical, Demographic and Laboratory Findings in Cases with Cerebral Palsy PatientsEvaluation of the etiology, prognosis and clinical findings in cases with cerebral palsy patients in this study.The medical records of patients who were followed and diagnosed as cerebral palsy in Child Neurology Department and also applied to hospital were reviewed, their physical and neurological examinations were performed. Other patients medical records were examined retrospectively.In this study, 520 patients of which 63,5% male and 36,5% female were included. The distribution of the cases according to clinical description was as follows: 71,9% of the patients were mature, 2,7% of the patients were postmature and 25,4% of them were premature. Male/female ratio was 1.71, 53,8% spastic tetraplegia, 17,7% spastic diplegia, 16,9% spastic hemiplegia, 1,2% ataxic CP, 8,7% discinetic CP and 1,7% hypotonic CP. The risk factors were classified etiologically to three as prenatal, perinatal and postnatal. Hypoxic ischemic encephalopathy was the most frequent risc factor with a frequency of 36,9%. Thereafter, it was assigned low birth weight with 35,3% of cases and nulliparity with 34,6% of them. Prenatal and perinatal risk factors are the major risk factors fort he development of CP. These findings were consistent with the other studies performedin the developing countries. 80,2% of cases revealed pathological findings on cranial magnetic resonance imaging. Pathologies which was mostly identified in premature cases were PVL (41,2%), local infarct (10,6%), bazal ganglia and thalamus lesions (6,9%) generalized cerebral atrophy (25,8%) and encephalomalacia (5%). Most frequent pathologies in matures were PVL (16,2%), local infarct (12,3%), ensefalomalasia (9,8%), diffuse cerebral atrophy (21,3%), and bazal ganglia and thalamus lesions (8,3%). In bone mineral density mesurement, we found z score below -2 in 40,8% of cases consistent with the other studies. In our study , we found that there is delay in visual evoked potentials (VEP) of the 61,3 % cases and brain stem auditory evoked potentials (BAEP) of the 52,7% of our cases. Epilepsy was found in 29,6% of the cases and focal epileptiform anomali was found to be the most commen EEG pathology 41,7%.CP is most important cause of morbidity and mortality for the Turkey. The present study demonstrated that frequency of CP can be attenuated by the improvement of the conditions of delivery rooms, follow-up of pregnancies should be done more carefully and perinatal risk factors should be vitiated and birth team standarts and management of postnatal follow-up in hospital conditions.
The Evaluation of Etiological, Clinical, Demographic and Laboratory Findings in Cases with Cerebral Palsy PatientsEvaluation of the etiology, prognosis and clinical findings in cases with cerebral palsy patients in this study.The medical records of patients who were followed and diagnosed as cerebral palsy in Child Neurology Department and also applied to hospital were reviewed, their physical and neurological examinations were performed. Other patients medical records were examined retrospectively.In this study, 520 patients of which 63,5% male and 36,5% female were included. The distribution of the cases according to clinical description was as follows: 71,9% of the patients were mature, 2,7% of the patients were postmature and 25,4% of them were premature. Male/female ratio was 1.71, 53,8% spastic tetraplegia, 17,7% spastic diplegia, 16,9% spastic hemiplegia, 1,2% ataxic CP, 8,7% discinetic CP and 1,7% hypotonic CP. The risk factors were classified etiologically to three as prenatal, perinatal and postnatal. Hypoxic ischemic encephalopathy was the most frequent risc factor with a frequency of 36,9%. Thereafter, it was assigned low birth weight with 35,3% of cases and nulliparity with 34,6% of them. Prenatal and perinatal risk factors are the major risk factors fort he development of CP. These findings were consistent with the other studies performedin the developing countries. 80,2% of cases revealed pathological findings on cranial magnetic resonance imaging. Pathologies which was mostly identified in premature cases were PVL (41,2%), local infarct (10,6%), bazal ganglia and thalamus lesions (6,9%) generalized cerebral atrophy (25,8%) and encephalomalacia (5%). Most frequent pathologies in matures were PVL (16,2%), local infarct (12,3%), ensefalomalasia (9,8%), diffuse cerebral atrophy (21,3%), and bazal ganglia and thalamus lesions (8,3%). In bone mineral density mesurement, we found z score below -2 in 40,8% of cases consistent with the other studies. In our study , we found that there is delay in visual evoked potentials (VEP) of the 61,3 % cases and brain stem auditory evoked potentials (BAEP) of the 52,7% of our cases. Epilepsy was found in 29,6% of the cases and focal epileptiform anomali was found to be the most commen EEG pathology 41,7%.CP is most important cause of morbidity and mortality for the Turkey. The present study demonstrated that frequency of CP can be attenuated by the improvement of the conditions of delivery rooms, follow-up of pregnancies should be done more carefully and perinatal risk factors should be vitiated and birth team standarts and management of postnatal follow-up in hospital conditions.
Description
Keywords
Serebral palsi, Epilepsi, Prognoz, Cerebral palsy, Epilepsy, Prognosis
Citation
Sincar, Ş. (2012). Serebral palsili hastalarımızın etiyolojik, klinik, demografik ve laboratuvar bulgularının değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.