Cerebral Palsy maybe/maybe not

SPASTIC DIPLEGIA

Spastic diplegia is about 30% or more of actual cerebral palsy cases. The descriptions imply things that just are not true.

Let’s dissect this. Getting description right requires getting perception of what you are seeing right. Spastic diplegia may be the greatest optical illusion on Earth! Had everybody fooled – including me. So, diplegia ("two limbs weak") has come to mean that which results from tiny speckled white infarcts (or small dead spots) scattered just outside the periphery of the ventricles of the brain ( whether two limbs are involved or not ). In microscopy lingo that description becomes periventricular leukomalacia (PVL). Peri= around, ventricular=relative to ventricles (fluid cisterns in the brain), leuko = white or clear colored, malacia= oooy gooey or mush, or pathologically "soft". The premature brain has a network of extra blood vessels that deliver blood to the brain surface or cortex. This is protective of the cortex when flow pressure drops for any reason. The least served area for low flow is adjacent the ventricles as that is a fluid region devoid of solid structures. Adjacent the ventricles (periventricular) is bay side property. When the winds of trouble blow in the preemie, the bay side property gets hit most. When PVL speckled damage is confined to a small region, manifestation of malfunction may well be in the legs only. Perhaps, just the ankles. Maybe just a trace of ankle reflex sensitivity not even noticed clinically at all. Typical PVL can be one sided in which case the diplegia is really only one leg ( hemi-diplegia ).

As the scope of these small PVL injuries scatters further out in a larger radius into the periventricular brain suburbs, hands and arms may also be involved