The clinical and etiologic profile of spastic diplegia was studied in a retrospective chart review of 54 patients diagnosed during a 12-year period at Montreal Children’s Hospital, Quebec, Canada. Thirty-one (57.4%) were preterm children, and 23 (42.6%) term children. Initial concerns were gait abnormality in 18 (33.3%), global developmental delay in 7 (13%), motor delay in 6 (11.1%), seizure in 3 (5.6%), and hypotonia in 2 (3.7%). ADHD was an associated comorbidity in 7 (13%). The diagnosis was periventricular leukomalacia (PVL) in 24 (44.4%) children; 26.1% were term and 58.1% preterm. The etiology was undetermined in 25 (46.3%) children. Ischemic stroke occurred in 3 (5.6%). PVL correlated with a birth weight of less than 2000 gm, history of neonatal resuscitation, and gestation less than 33 weeks. In term children, PVL was associated with perinatal difficulties, neonatal resuscitation, and a history of neonatal distress. 
COMMENT. The authors list further investigations to identify the cause of spastic diplegia in the high proportion (46%) of patients undiagnosed. These investigations include repeat MRI, spinal imaging, voxel-based morphometry, and diffusion-weighted MRI in the acute stage of PVL.