Sebahattin VURUCU, OKTAY SARI, Mustafa GÜLGÜN, BÜLENT ÜNAY, Rıdvan AKIN, Okan ÖZCAN

Serebral palsili hastalarımızın etiyolojik, klinik ve laboratuvar bulgularının değerlendirilmesi

AMAÇ: Biz bu çalışmada serebral palsili (SP) hastalarımıza ait etiyolojik risk faktörlerini, klinik ve laboratuvar bulgularını literatür bilgileri doğrultusunda tartışmayı amaçladık. YÖNTEM: Hastalara ait cinsiyet, tanı yaşı, ailelerin sosyal statüsü, doğum şekli, SP tipi, risk faktörleri, eşlik eden hastalıklar, beyin görüntüleme ve elektroensefalografi (EEG) bilgileri takip dosyalarından elde edilerek kaydedildi. BULGULAR: Çalışmada 180 hastanın dosya bilgileri değerlendirmeye alındı. Hastaların %58.3’ü erkek, %41.7’si kız ve ortalama tanı yaşı 8.98 ± 5.34 ay idi. Hastaların %77.8’i vajinal yolla ve %22.2’si sezaryan ameliyatı ile doğurtulmuş olup vajinal yolla doğurtulmuş olanlarda eşlik eden hastalıkların oranı istatistiksel olarak önemli derecede daha yüksek, tanı yaşı daha düşük olarak saptandı (sırasıyla p=0,027, p=0,031). Hastaların %88.3’ü spastik, %10.6’sı ataksik-hipotonik ve %1.2’si diğer SP tiplerine sahipti. Hastaların %51,1’i en az bir etiyolojik risk faktörüne sahipti. En sık etiyolojik risk faktörleri perinatal asfiksi (%22.7), prematürite (%15.5), düşük doğum ağırlığı (%7.2) ve diğer nedenlerden (%18.9) ibaretti. Hastaların %79.5’inde SP’ye eşlik eden en az bir hastalık saptandı. En sık eşlik eden hastalıklar konuşma bozukluğu (%60), göz anormallikleri (%56.6), mental retardasyon (%53.3), epilepsi (%41.1) ve diğer hastalıklar (%12.1) olarak saptandı. Hastaların %85.6’sında beyin görüntüleme tetkiklerinde en az bir patolojik bulgu mevcuttu. En sık beyin görüntüleme anormallikleri kortikal atrofi (%34.4), korpus kallozum anomalisi (%20), periventriküler lökomalazi (%16.6), ensefalomalazi (%10.5), serebral infarkt (%10), hipoksik iskemik ensefalopati (%6.6) ve diğer anormallikler (%11.9) idi. SONUÇ: Hastalarımızın çoğunluğu spastik tip SP’li olup yüksek oranlarda konuşma bozukluğu, göz anormallikleri, mental retardasyon ve epilepsi gibi eşlik eden hastalıklara, kortikal atrofi, korpus kallozum anomalisi ve periventriküler lökomalazi gibi beyin görüntüleme anormalliklerine sahipti. Bu durum bize özellikle beyin manyetik rezonans görüntüleme bulguları ile SP prognozu arasında bir ilişki kurulabileceğini düşündürmüştür.

Anahtar Kelimeler:

Beyin felci, Tıbbi kayıtlar, Risk faktörleri, Cinsiyet dağılımı

Evaluation of the etiological, clinical and laboratory findings in patients with cerebral palsy

AIM: In this study we aimed to discuss the etiological risk factors, clinical and laboratory findings of the patients with cerebral palsy (CP) according to the literature of knowledges. METHOD: The data including sex, age, social status of families, method of delivery, type of CP, risk factors, comorbidities, brain imaging and electroencephalograpy findings were retrospectively recorded from the patients’ files. RESULTS: A total of 180 patients were included in this study. Of the patients 58.3% were boy, 41.7% were girl, and mean age at diagnosis was 8.98±5.34 months. Of the patients 77.8% had vaginal birth, 22.2% had cesarean birth. The patients who had vaginal birth had statisticaly higher ratio of comorbidity, and lower mean diagnostic age, respectively (respectively p=0,027, p=0,031). Of the patients 88.3% had spastic CP, 10.6% had ataxic-hypotonic CP and 1.2% had other CP types. Of the patients 51,1% had at least one etiological risk factors. Most common etiological risk factors were perianal asfixi (22.7%), prematürity (15.5%), small for gestational age (7.2%) and others (18.9%). Of the patients 79.5% had at least one comorbidity. Most common comorbidities were lenguage disabilities (60%), eye abnormalities (56.6%), mental retardation (53.3%), epilepsy (41.1%) and others (12.1%). Of the patients 85.6% had at least one brain imaging abnormality. Most common brain imaging abnormalities were cortical atrophy (34.4%), abnormalities of corpus callosum (20%), periventricular leukomalacia (16.6%), encephalomalasia (10.5%), cerebral infarction (10%), hypoxic ischemic encephalopaty (6.6%) and others (11.9%). CONCLUSİON: Most of the our patients had spastic type CP, comorbidities including lenguage disabilities, eye abnormalities, mental retardation, and epilepsy and brain imaging abnormalities including cortical atrophy, abnormalities of corpus callosum, and periventricular leukomalacia. Therefore we consider that there may be a relationship between brain imaging abnormalities and prognosis of CP.

Keywords:

Cerebral Palsy, Medical Records, Risk Factors, Sex Distribution,

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