The MRI findings in 34 children with spastic diplegia examined between 2 and 10 years of age are reported from the Seirei-Hamamatsu General Hospital, Mikatabara, Hammamatsu, Shizuoka; Nagoya City Medical School; and the National Rehabilitation Center for Disabled Children, Tokyo, Japan. There was dilation of the trigone, atrophy of the peritrigonal white matter, and prominent deep cortical sulci. The appearance of cerebral white matter was classified into four patterns: 1) normal; 2) peritrigonal white matter showing a thin contiguous line in one hemisphere; 3) peritrigonal white matter reduced in both hemispheres; and 4) the reduction of the white matter expanded anteriorly from the trigones to the bodies of the lateral ventricles. The degree of cerebral white matter loss correlated with severity of motor disability but not with severity of mental impairment. The distribution of periventricular high intensity T2-weighted images did not correlate with motor or mental disability. [1]

COMMENT. The MRI findings were similar to those reported with periventricular leukomalacia. In infancy leukomalacia is characterized by delayed myelination and demonstrated as high intensity areas on T2 weighted images. It occurs most commonly in preterm infants and all but three of the children in this study had birth weights lower than 2000 grams. Mild degrees of periventricular white matter reduction are often interpreted as a normal variant in children, but correlations with delay in motor development should be considered.