Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction, communication difficulties, and the presence of restricted, repetitive, and stereotyped patterns of behavior. According to Centers for Disease Control and Prevention the prevalence of ASD has increased from 1:150 (1992) to 1:67 (2012). Despite many research projects and advanced neuroimaging studies performed as part of ASD research, brain magnetic resonance imaging (MRI) is not recommended as part of routine evaluation, a decision supported by American Academy of Neurology, the Child Neurology Society, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Pediatrics. Therefore, we wished to identify the prevalence of neuro-pathological findings in our ASD patients.
Methods: Retrospective electrical medical record (EMR) review of 2321 patients registered in the database of Thompson Center at University of Missouri Healthcare and Clinic between October 1990 and July 2013 was performed to identify the prevalence of MRI abnormalities in ASD patients.
Results: 579 patients had brain MRI. 386 patients had normal studies. 182 patients, 31.4% (Male: female=142:40) demonstrated 208 abnormal findings. Cerebellum ecotopia(3.5%) was the most common , followed by venous anomaly (2.6%), arachnoid cyst (2.9%), Periventricular abnormality (2.1%), Chiari I malformation (1.6%),ventricle dilation/hydrocephalus(1.4%) , cortical dysplasia(0.7%), possible temporal sclerosis(0.5%), tuber sclerosis (0.18%) and three brain tumors.
Conclusions: Intracranial abnormalities are relatively common in patients with ASD, suggesting that these abnormalities have likely been under-recognized. Prevalence was 10 times higher than previous report. Identifying chief complaints and performing clinical assessment of ASD patients is difficult since patients have impairment of communication. Treatable surgical pathologies like Chiari I malformation, cortical dysplasia, hydrocephalus, and arachnoid cyst, which are likely underdiagnosed in ASD patients, may affect patient functional outcome. The necessity of routine brain MRI in patients with ASD should be re-evaluated and likely be instituted.
Patient Care: Identify neurological treatable causes in Autism spectrum disorders.
Learning Objectives: To identify under-recognized treatable cause in Autism spectrum disorder
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