Early Detection and Management of Cerebral Palsy by H. Galjaard, H.F.R. Prechtl, M. Velickovic

By H. Galjaard, H.F.R. Prechtl, M. Velickovic

At the tip of September 1984 Dr. M. Velickovi~ and Prof. H. Prechtl with the aid of the overseas Cerebral Palsy Society equipped a world convention on "New strengthen­ ments within the overview of early mind harm" in Bled, Yugo­ slavia. i used to be invited as a speaker at this convention and that i went there, curious, yet with out an excessive amount of wisdom in regards to the crucial subject: cerebral palsy. in the course of the convention and a satellite tv for pc assembly I turned inspired by means of the standard of varied contributions and likewise via the nice number of difficulties concerning the etiology, early analysis, administration and psychosocial facets of cerebral palsy. at the present time, in lots of components of biology and medication, growth turns out to require focus on a really slim box. subsequently many meetings are hugely really expert and so much (young) scientists rightly contemplate this as Most worthy for his or her personal paintings. nevertheless the care of sufferers and counselling of folks and different shut kinfolk require a multidisciplinary process. additionally, advances within the learn of advanced un­ resolved clinical organic pr'oblems are usually made unex­ pectedly by utilizing rules, theories, ways or equipment from different disciplines.

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8). 3. CRANIAL DEFECTS Precise ultrasonic visualization of normal and pathologic fetal intracranial structures, enabled experienced investigators to diagnose with almost 100% accuracy the most frequently encountered cranial defects such as anencephaly, hydrocephaly and microcephaly~ Early diagnosis of these abnormalities, described below, is still the most successful application of ultrasound. 1. Anencephalv Anencephaly results from an arrest of neural groove closure in the brain. It is thus a disorder of early embriogenesis, caused by defective induction of the prechordal place, the parachordal mesoderm, or poor receptivity of the competent neural plate (3).

Carrying a fetus with a known congenital abnormality incompatibile with life, exposes the pregnant woman to unnecessary psychological, social and S2 physical risk if the pregnancy can be safely terminated (8). According to our experience the use of ultrasonically guided intraamniotic injections of Prostaglandine F2 alpha is the method of choice in such cases. 2. Hydrocephaly Hydrocephaly is characterized by abnormal accumulation of cerebrospinal fluid ~n the ventricles or, in case of external hydrocephaly, in the subarachnoidal spaces.

54 The greatest hemispheric width is also measured at the same level as the ventricular width. These measurements shoulq be taken from the inner edge of the midline echo to the inner edge of the distal parietal bone respectively. A potential pitfall in determing the lateral ventricle width/ hemispheric width ratio (LVW/HW) lies in mistaking the Sylvian fissure for the lateral wall of the ventricular bodYi such a mistake could be the cause of erroneus diagnosis of hydrocephaly. The Sylvian fissure can be distinguished easily fxom the ventricular wall because it lies more laterally at a slightly lower level.

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