Publication

Abstract : A 7-year-old boy presented with isolated motor development delay and toe-walking. He was born preterm (32 weeks), appropriate for gestational age and the rest of the antenatal and perinatal history was noncontributory. He could walk independently but had difficulty while running. He had no difficulty in getting up from the floor or climbing stairs. There was no history suggestive of involvement of neck, bulbar, facial, and proximal muscles of the upper limbs. Examination revealed normal head circumference, bilateral calf hypertrophy [Figure 1], and hyperreflexia at both knees with fixed contractures of bilateral ankles with an average intelligence quotient. He did not have an evident spasticity at joints (besides ankle with fixed contractures). A clinical diagnosis of spastic diplegia was confirmed. Neuroimaging revealed altered periventricular and peritrigonal white matter signal intensities suggestive of periventricular leukomalacia. Creatine kinase levels were within normal limits.