Abnormal neuroimaging is associated with early in-hospital seizures in pediatric abusive head trauma.
BACKGROUND
Abusive head trauma (AHT) is a common condition in children. Little is known in this condition regarding the frequency of seizures, the factors associated with increased risk of seizures, or the association of seizures with outcome. We sought to determine frequency and risks for in-hospital seizures after AHT.


METHODS
This was a single-center, retrospective chart review study at a 270 bed tertiary care referral pediatric hospital.


RESULTS
A total of 54 cases of AHT were identified during the study period. During the first week following hospital admission, 33% of patients were observed to have clinical seizures. The occurrence of clinical seizures after admission was associated with findings on initial CT including midline shift, cerebral edema, and loss of gray white differentiation. MRI findings associated with clinical seizures after admission included midline shift, cerebral edema, infarction, and restricted diffusion. The presenting complaint of seizures or acute mental status changes well as a variety of abnormal imaging findings including gray white blurring, infarction, and edema were associated with short-term outcomes.


CONCLUSIONS
Specific neuroradiologic findings identify children at greater risk for seizures, both clinical and subclinical, following AHT. Clinical and subclinical seizures are common in the initial hospitalization for AHT.
Division of Neurology no. 51, Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza, Chicago, IL 60614, USA. jgoldstein@childrensmemorial.org
Joshua L
JL
Goldstein
Daniel
D
Leonhardt
Natalie
N
Kmytyuk
Francine
F
Kim
Deli
D
Wang
Mark S
MS
Wainwright
D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed