Abstract
Cortical laminar necrosis is a histopathological entity, related to conditions of
cerebral energy depletion. Clinical correlates are supposed to be spastic motor deficits,
decreased intellectual capacity and epilepsy.
A study was performed in 45 children with cortical laminar abnormalities in signal
intensity on MRI. The purpose of the study was to evaluate causes and clinical consequences
of these cortical abnormalities on MRI in order to find indirect evidence for the
hypothesis that they may represent cortical laminar necrosis. In view of the frequently
present concomitant white matter damage, two contrast groups were formed: one group
of 40 children with periventricular white matter abnormalities, part of them with
subcortical extensions of the white matter damage; and another group of 53 children
without abnormalities on MRI. Data concerning history, present clinical condition
and final diagnosis were collected.
The presence of cortical laminar abnormalities on MRI was found to be strongly associated
with a history of cerebral energy depletion, especially hypoxia-ischemia, either in
the perinatal period or later in life. Whereas white matter abnormalities tended to
be more frequent in premature children, cortical laminar abnormalities tended to occur
more frequently in term neonates and older children.
The presence of cortical laminar abnormalities on MRI was correlated with an increased
risk of spasticity in children without concomitant white matter abnormalities. In
children with white matter lesions, cortical laminar abnormalities did not contribute
to the risk of spasticity, which was already highly increased by the presence of white
matter damage. No association was found between cortical abnormalities on MRI and
epilepsy or psychomotor retardation.
The association between cortical laminar abnormalities on MRI and an episode of cerebral
energy depletion is consistent with and can be considered as indirect evidence for
the hypothesis that they may represent a mild form of cortical laminar necrosis as
known from histopathology.
Key words
Cortical laminar abnormalities - Hypoxiaischemia - MRI
