Periventricular leukomalacia (PVL) due to hypoxic ischemic insults to vulnerable periventricular white matter is believed to be one of the major etiologic factors in children with spastic cerebral palsy (CP). It is generally assumed that the damage to the corticospinal tract accounts for most tone and movement abnormalities in these children. However, children with PVL do not always produce clinical features of spastic CP and conversely, spastic type CP patients do not always have PVL. In fact, PVL is present in approximately 70-75% of spastic diplegic CP born before 32 weeks of gestation. Also, the damage to the corticospinal tract has not been clearly established anatomically by imaging modalities. In addition, the exact correlation between brain damage and these motor impairments still remains unclear. Recently, advances in neuroimaging technique play an increasing role in researching the pathophysiology of abnormal motor function in CP.
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