A prospective study on transcranial color duplex sonography (TCCD) was performed with 94 healthy children and adolescents between 3 and 18 years of age (age and sex evenly distributed) in order to provide normal data on angle-corrected ("true") flow velocities and wave-form parameters of the main supra- and infratentorial basal cerebral arteries. Using a 2.0 MHz transducer of a computed sonography system, we examined the anterior, middle, and posterior cerebral arteries of either side transcranially, and the vertebrobasilar system suboccipitally. In all arteries, flow velocities decreased continuously from early childhood to adulthood, while wave-form parameters remained constant. There was no difference in flow velocities, and wave-form parameters between girls and boys. On the average, the angle-corrected flow velocities measured by TCCD were about 10%-20% higher than the reference data provided in "blind" transcranial Doppler studies by other groups for the anterior and posterior cerebral arteries as well as the basilar artery, while there were only small differences in the values for the middle cerebral artery. Side-to-side differences in flow velocities were lower in the middle and posterior cerebral arteries than in the anterior cerebral and the vertebral arteries. The reference data presented here provide a basis for the clinical application of the TCCD method in children and adolescents.
Transcranial color duplex sonographic examinations in children and adolescents without cerebrovascular disease were evaluated retrospectively. Flow velocities and waveform parameters were determined and their side-to-side differences and age dependence analyzed and, finally, compared with analogous data of a previously described group of healthy adults.With a 2.0-MHz sector transducer of a computed sonographic system, the anterior, middle, and posterior cerebral arteries were examined in 64 children and adolescents between 1.5 and 17.5 years of age. Angle-corrected systolic peak, end-diastolic maximum, time-averaged, and time-averaged maximum velocities, and the resistance, pulsatility, and spectral broadening indexes were determined in all vessels.Mean +/- SD values for time-averaged maximum velocity (and time-averaged velocity) were 92.2 +/- 13.0, 79.9 +/- 17.7, and 63.9 +/- 13.6 (55.3 +/- 11.7, 40.4 +/- 10.4, and 34.2 +/- 9.2) cm/s, respectively, in the middle, anterior, and posterior cerebral arteries in children under 10 years of age; values were 83.2 +/- 11.9, 69.4 +/- 13.8, and 55.6 +/- 10.1 (50.8 +/- 9.0, 39.9 +/- 10.5, and 33.1 +/- 6.3) cm/s, respectively, in children 10 years of age and older. Time-averaged maximum velocity decreased significantly with age in all vessels (P < .001). Although time-averaged velocity did not change significantly during childhood and adolescence, a clear decline occurred from adolescence to adulthood (P < .0001 in the middle and posterior cerebral arteries; P < .01 in the anterior cerebral artery). The spectral broadening index decreased significantly from childhood to adolescence in the anterior and posterior cerebral arteries (P < .0001). The resistance and pulsatility indexes remained stable throughout childhood.Transcranial color duplex sonography allows angle-corrected measurements of "true" flow velocities in basal cerebral arteries. Additional determination of time-averaged velocity permits more detailed evaluation of flow characteristics for all age groups. The transcranial color duplex technique may provide deeper insights on normal cerebral perfusion and its disorders.
SUMMARY The authors report on the clinical examination and magnetic resonance imaging (MRI) of 41 children (29 term and 12 preterm) whose diagnosis of congenïtal hemiparesis was confirmed after the first year of life. Periventricular leukomalacia was the most predominant MRI finding (found in 15 term and eight preterm infants). The uniform pattern of lesions observed through MRI (without clear correlation with gestational age) suggests a common aetiopathogenesis in this subgroup. Comparison of these MR images with the periventricular leukomalacia observed in preterm children with spastic diplegia supports the thesis that ischaemia occurring between the 28th and 35th weeks of gestation could be the main cause. RÉSUMÉ Hémiparésie congénitale et leucomalacie périventricular: aspects pathogéniques à partir d'IRM Les auteurs rendent compte de l'examen clinique et des données IRM chez 41 enfants (29 nés a terme et 12 prématurés) chez qui un diagnostic d'hémiparésie congénitale avait été confirmé aprés l'àge d'un an. I.a leucomalacie périventriculaire avait été la donnée IRM la plus habituelle (trouvée chez 15 sujets nés a terme et huit prématurés). La distribution uniforme des lésions observées à l'IRM (sans corrélation évidente avec l'âge de gestation à la naissance) suggère une étiopathogcnie commune à ce sous‐groupe. La comparaison de ces IRM avec la leucomalacie périventriculaire observée chez les prematurés porteurs d'une diplegie spastique, est en faveur de la thése selon laquelle une ischémic sutvenam entre la 28éme et la 35cme semaine de gestation pourrait être la cause principale. ZUSAMMENFASSUNG Congenitale Hemiparese und periventrikuläre Leukomalazie: pathogenetische Aspekte der Kernspin‐Unlersuchung Die Autoren berichten über klinische Untersuchungen und Kernspin (MR1) Befunde, bei 41 Kindern (29 reif‐ und 12 frühgeborene Kinder), bei denen die Diagnose der congenitalen Hemiparese nach dem ersten Lebensjahr bestätigt wurde. Der wichtigste MRI Befund war die periventrikuläre Leukomalazie (bei 15 reif‐ und acht frühgeborenen Kindern nachgewiesen). Das übereinstimmende Bild der Läsionen im MRI (ohne eindcutige Korrelation zum Gestationsalter) läßit eine gemeinsame Aetiopathogenese bei dieser Untergruppe vermuten. Der Vergleich dieser MRI Befunde mit der periventrikulären Leukomalazie bei Fruhgeborenen mit spastischer Diplegie spricht für die Hypothese, daß eine Ischämie in der Zeit von der 28. bis 35. Gestationswoche die Hauptursache sein könnte. RESUMEN Hemiparesia congenita y leucomalacia peri‐ventricular: aspectos patogénicos a partir de la IRM Los autores aportan los datos clinicos y de IRM dc 41 niños (29 a término y 12 pretérmino), en los que el diagnóstico de hemiparesia congénita fue confirmada después del primer año de vida. La leucomalacia periventricular era el hallaz. go por IRM mas predominante (fue confirmado en 15 a término y en ocho pretérmino). El partón uniforme de las lesiones observadas por la IRM (sin una clara correlación con la edad gestacional) sugiere que hay una etiopatogenia comiin en estc subgroupo. La comparación de estas imagenes por RM con la leucomalacia observada en niños pretermino con diplegia espástica, apoya la tesis de que la isquemia que tiene lugar entre las semanas 28 y 35 de gestateón puede ser la causa principal.
