Neonatal seizures associated with cerebral lesions shown by magnetic resonance imaging.
OBJECTIVE
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.


METHODS
Thirty 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.


RESULTS
Brain 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 2 1/2 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%.


CONCLUSIONS
MRI 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.
Leth
H
H
Danish Research Center for Magnetic Resonance, University Hospital Hvidovre, Denmark.
Toft
P B
PB
Herning
M
M
Peitersen
B
B
Lou
H C
HC
D001921:Brain / Q000002:abnormalities / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D004453:Echoencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D008659:Metabolic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012640:Seizures / Q000000981:diagnostic imaging / Q000473:pathology*