The aetiology of neonatal seizures and the diagnostic contribution of neonatal cerebral magnetic resonance imaging.
OBJECTIVE
The aim of this study was to delineate aetiologies and explore the diagnostic value of cerebral magnetic resonance imaging (MRI) in addition to cranial ultrasonography (cUS) in infants presenting with neonatal seizures.


METHODS
This retrospective cohort study comprised infants (gestational age 35.0-42.6wks) with seizures, confirmed by either continuous amplitude-integrated electroencephalography (aEEG) or standard EEG and admitted during a 14-year period to a level three neonatal intensive care unit (n=378; 216 males, 162 females; mean [SD] birthweight 3334g [594]). All infants underwent cUS and MRI (MRI on median of 5 days after birth, range 0-58d) within the first admission period.


RESULTS
An underlying aetiology was identified in 354 infants (93.7%). The most common aetiologies identified were hypoxic-ischaemic encephalopathy (46%), intracranial haemorrhage (12.2%), and perinatal arterial ischaemic stroke (10.6%). When comparing MRI with cUS in these 354 infants MRI showed new findings which did not become apparent on cUS, contributing to a diagnosis in 42 (11.9%) infants and providing additional information to cUS, contributing to a diagnosis in 141 (39.8%). cUS alone would have allowed a diagnosis in only 37.9% of infants (134/354).


CONCLUSIONS
Cerebral MRI contributed to making a diagnosis in the majority of infants. In 11.9% of infants the diagnosis would have been missed if only cUS were used and cerebral MRI added significantly to the information obtained in 39.8% of infants. These data suggest that cerebral MRI should be performed in all newborn infants presenting with EEG- or aEEG-confirmed seizures.
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Lauren C
LC
Weeke
Floris
F
Groenendaal
Mona C
MC
Toet
Manon J N L
MJ
Benders
Rutger A J
RA
Nievelstein
Linda G M
LG
van Rooij
Linda S
LS
de Vries
D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000592:standards*