Background/Purpose: Almost all patients with severe affections of the brain receive CTs or MRIs in the
acute phase of their disease. These investigations yield import information for surgical
and non-surgical therapeutic measures in the acute phase. In addition, with a good
knowledge of functional anatomy, these investigations allow a detection of specific
functional deficits, often at a time when these deficits are not yet evident during
physical examination. Furthermore, when the rules of neuroplasticity in the developing
brain are known, these images yield important information also for the prognosis of
these deficits. These correlations are usually not mentioned in neuroradiological
reports. Therefore, the pediatric neurologist (leading the therapeutic team) must
reanalyze these images, draw the relevant conclusions, and demonstrate and communicate
them with the team.
Methods: For patients admitted for neurorehabilitation in our institution, we request CT and
MRI investigations from the referring hospitals on CD-ROM, and re-analyze these images
systematically with respect to neurorehabilitative information.
Results: Frequent radiologically identified deficits are: Cerebral visual impairment (global/hemianopia),
dysarthria (vs. aphasia) in children with bilateral lesions to the primary-sensorimotor
face areas or their tracts/of the basal ganglia. Frequent radiology-based prognoses
are permanent loss of active hand function (destruction of primary motor hand area
or its corticospinal tracts) and persisting aphasia (severe destruction of language
areas beyond kindergarten age). In addition, more complex correlations can be helpful
for therapeutic work, such as explaining a global perception problem with bi-parietal
lesions or deficits in impulse control with bi-frontal lesions.
Conclusion: Analyzing brain imaging studies in the context of neurorehabilitation can yield important
information for goal-finding and choosing adequate therapeutic measures.
