Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

Abstract

INTRODUCTIONSeizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome.1-4 A specific etiology for the seizure can be better detected in infants compared to children. 5However in 12-15% of newborns the etiology remains unknown.6-8 Magnetic resonance imaging (MRI) is a valuable tool for identifying structural abnormalities which may be the underlying etiology for neonatal seizures and it is also more sensitive to detect subtle changes compared to neurosonogram or computed tomography. 9 In developed countries, MRI of brain has become a standard investigation over a period of time but not yet in developing countries due to the lack of availability of equipment and expertise.7,10 MRI is not only helpful to detect the underlying brain etiology but also to prognosticate. 11Data on MRI findings in neonatal seizures are sparse in developing countries. Hence the objective of this study is ABSTRACT Background: Seizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome. The aim of the study was to describe the spectrum of brain lesions identified by magnetic resonance imaging (MRI) in term babies presenting with neonatal seizures. Methods: This retrospective descriptive study was done in a tertiary care hospital. The study subjects included term neonates presenting with neonatal seizures admitted in neonatal intensive care unit over a 5 year period, who underwent MRI brain. Data was collected from the medical records and radiology department. Results: Out of 189 neonates presenting with seizures, 155 underwent MRI brain. Brain lesions were identified in 122 (79%) babies. The most common etiological diagnosis was hypoxic ischemic encephalopathy (HIE) which was noted in 43 (28%) neonates. The other findings in the decreasing order were encephalitis in 35 (23%), metabolic disorder in 16 (10%), haemorrhage in 15 (9.7%) vascular in 12 (8%) and cortical dysplasia in 1 (<1%) neonates. Conclusions: MRI identified brain lesions in 79% of infants who presented with neonatal seizures. In accordance with the literature, our studies also revealed HIE as the commonest brain lesion. The diagnosis of neonatal stroke and encephalitis was made specifically with the aid of MRI. MRI showed changes consistent with diagnosis of encephalitis in a significant proportion of babies. We suggest that MRI should be considered as a standard investigation during the evaluation and management of neonatal seizures.

Spectrum of MRI abnormalities in pediatric seizures

“…Magnetic resonance imaging (MRI) is the main investigation to identify structural abnormalities which may be the underlying cause for seizures in neonates and it has a more sensitivity to detect subtle changes as compared to neurosonogram or CT scan [23].…”

“…MRI of the brain has become a standard imaging modality for pediatric seizures in developed countries over a period of time but not yet in developing countries due to the shortage of availability of equipment and expertise. MRI does not only help to detect the underlying brain etiology of seizure but also helps in predicting the prognosis [23].…”