NEONATAL SEIZURES ASSOCIATED WITH CEREBRAL-LESIONS SHOWN BY MAGNETIC-RESONANCE-IMAGING

Aim-To determine the diagnostic potential of magnetic resonance imagin g (MRI) in neonatal seizures; to elucidate the aetiology, timing, and prognosis of the cerebral lesions detected. Methods-Thirty one term ne onates 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 (m ean 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. Resul ts-Brain abnormality was demonstrated by MRI in 68% of infants and ult rasonographically 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 lesi ons were presumed to have antepartum origin in 43% of cases. Seizure a etiology was considered to be hypoxic-ischaemic in 35%, haemorrhagic i n 26%, metabolic disturbances and cerebral dysgenesis in 16% and unkno wn in 23%. Conclusions-MRI detected a remarkably high incidence of bra in lesions in neonatal seizures. Almost half of these were of prenatal origin and pathogenesis may essentially be attributed to hypoxic and/ or haemodynamic causes.