Value of brain MR imaging in infants with a severe idiopathic apparent life threatening event

Objective. Prognostic value of a magnetic resonance imaging (MRI) scoring s ystem in infants with a severe apparent life threatening event (ALTE). Methods. Ten infants with an ALTE (aged between 6 and 31 weeks) were clinic ally graded according to the PRISM score and evaluated with EEG, evoked pot entials and MRI. The 18 MRIs obtained were distributed in 3 classes accordi ng to the delay after which they were obtained; class A (n=5): within the f irst 48 hours after the event, class B (n=7): between day 3 and 8 and class C (n=6): between day 9 and 50. The 18 MRIs were evaluated retrospectively using a scoring system based on 3 categories of lesions: edema, basal ganglia injury and watershed injuries . Five infants died between day 2 and day 15 after the event. The five surv iving infants had follow-up neurodevelopmental testing after 38 to 77 month s. Results. There was no correlation between the 5 MRIs of class A and the neu rological outcome. For the MRIs of class B and C, the scoring system can be of great Value when combined with the scores of EEG, EP and PRISM. Conclusions. The scoring system for MRI performed within 48 hours after the event is falsely reassuring. MRI can be helpful as early as 3 days after t he event when combined with the score of the electrophysiological investiga tions and the PRISM.