Magnetic resonance imaging and ultrasound injury in preterm infants with seizures

Abstract

Although the utility of magnetic resonance imaging (MRI) as a universal screening tool in preterm infants has been contested, it is increasingly used to investigate neonatal seizures. The authors evaluated 236 infants <34 weeks' gestation at birth. Seizures were documented according to the clinical standard of care. Infants underwent MRI and head ultrasound during the neonatal period, and a neuroradiologist and ultrasonologist performed detailed reviews of the images. During the hospital course, 9 infants (3.8%) had clinical suspicion of seizures. Magnetic resonance imaging was abnormal in each case. Periventricular hemorrhagic infarct was more common in infants with seizures. Infants with seizures were more likely to have white matter injury, though the difference was not significant. Head ultrasound failed to detect the extent of brain abnormality in 8 (89%) of the infants. In this large cohort, infants with clinical suspicion of seizures had a high rate of MRI abnormalities that were not as well characterized by head ultrasound. Magnetic resonance imaging may be the study of choice for evaluating preterm infants with seizures.

Figures

Figure 1. Neonatal magnetic resonance imaging in nine preterm infants with clinical seizures

A) 24-week male with seizures in the first week of life. Axial T2-weighted image at 25 weeks postmenstrual age (PMA) shows bilateral intraventricular hemorrhage (IVH) with parenchymal hemorrhage involving the basal ganglia and periventricular white matter on the left and caudate on the right with ventriculomegaly. Signal change in the thalami and basal ganglia in keeping with edema and possible hypoxic-ischemic injury. B) 24-week male with seizures in the 3rd week of life. Axial T2-weighted image at 36 weeks PMA shows right occipital schizencephaly. C) 24-week male with seizures on the first day of life. Axial T1-weighted image at 29 weeks PMA shows extensive posterior white matter and cortical injury with reduced gyrification suggestive of congenital infection or intrauterine toxin exposure. D) 25-week male with seizures on the day of birth. Axial T2-weighted image at 27 weeks PMA shows left IVH with parenchymal hemorrhagic infarct involving the periotrigonal area, plus right intraventricular hemorrhage with ventriculomegaly. Signal change in basal ganglia in keeping with hypoxic-ischemic injury. E) 28-week male with seizures on the 4th day of life. Axial T2-weighted image at 29 weeks PMA shows right IVH with hemorrhagic infarct and ventriculomegaly. Additional smaller left-sided intraventricular and parenchymal hemorrhages were also present. F) 28-week male with seizures and Candida sepsis during the 3rd week of life. Axial T1-weighted image at 33 weeks PMA shows numerous focal areas of white matter hyperintensity, many of which were enhancing. G) 29-week female with birth asphyxia and seizures on the 4th day of life. Axial T2-weighted image at 30 weeks PMA shows diffuse white matter injury with reduced signal in the ventrolateral thalami and basal ganglia, in keeping with hypoxic-ischemic injury. H) 31-week female with seizure and Staphylococcus aureus sepsis during the 4th week of life. Axial T2-weighted image at 36 weeks PMA shows diffuse and focal (arrow) white matter injury. I) 31-week male with seizures on the first day of life. Axial T1-weighted image at 32 weeks PMA shows left frontal dysplasia (arrow).