Which two perinatal brain injuries predispose to spastic diplegic cerebral palsy?

• A. Hypoxic-ischemic encephalopathy and germinal matrix hemorrhage
• B. Periventricular leukomalacia and intraventricular hemorrhage
• C. Subarachnoid hemorrhage and cortical contusions
• D. Intraparenchymal hemorrhage and parasagittal meningioma

Answer: (B)

Spastic diplegia from cerebral palsy most often traces to injury of the periventricular white matter in premature infants. Periventricular leukomalacia is a white matter necrosis caused by ischemia that directly damages the long corticospinal fibers as they pass near the ventricles. Because the leg-related fibers are located more medially in the posterior limb of the internal capsule and adjacent periventricular tracts, PVL tends to spare the arms and affect the legs more, giving a leg-dominant (diplegic) pattern of spasticity. Intraventricular hemorrhage, common in preterm infants, further injures this periventricular region and adds to white matter damage, reinforcing the same motor tract disruption that leads to spastic diplegia.

Other injuries listed either involve different brain regions or produce broader or different clinical pictures: hypoxic-ischemic encephalopathy can cause diffuse injury with various CP patterns; subarachnoid hemorrhage and cortical contusions center on the cortex or meningeal spaces and do not preferentially target the periventricular corticospinal tracts; intraparenchymal hemorrhage and parasagittal meningioma are not typical perinatal injuries associated with this lower-limb–predominant CP pattern.