Neonatal seizures associated with cerebral lesions shown by magnetic resonance imaging
a The Danish Research Center for Magnetic Resonance, b Department
of Paediatrics, University Hospital Hvidovre, c John F Kennedy Institute,
Glostrup, Denmark
Correspondence to: Dr Helle Leth, Department of Paediatrics, University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
Accepted 15 April 1997
AIM
To determine the diagnostic potential of
magnetic resonance imaging (MRI) in neonatal seizures; to elucidate the
aetiology, timing, and prognosis of the cerebral lesions detected.
METHODSThirty one term neonates with clinical
seizures underwent ultrasonography between days 1-7 (mean 2.5 days)
and a high field spin-echo MRI scan on days 1-30 (mean 8.1 days), both
of which were repeated at 3 months of age. Routine investigation
excluded, as far as possible, infection, haematological, and
metabolic-toxic causes as causes of the neonatal seizures.
RESULTSBrain abnormality was demonstrated by MRI
in 68% of infants and ultrasonographically in 10%. Diffuse brain
lesions (present in 29%) were associated with high mortality (58%)
and morbidity (42%), whatever the aetiology. In contrast to a better
short term prognosis for neonates with focal lesions where no infants
died, 33 % had a handicap, and the rest were normal at a mean follow up age of 21/2 years. Cerebral lesions were presumed to have
antepartum origin in 43% of cases. Seizure aetiology was considered to
be hypoxic-ischaemic in 35%, haemorrhagic in 26%, metabolic
disturbances and cerebral dysgenesis in 16% and unknown in 23%.
CONCLUSIONSMRI detected a remarkably high
incidence of brain lesions in neonatal seizures. Almost half of these
were of prenatal origin and pathogenesis may essentially be attributed
to hypoxic and/or haemodynamic causes.
© 1997 by Archives of Disease in Childhood
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