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

Shafi Jan M. Shaik, Ezhilarasan Ratnavelu, Umamaheswari Balakrishnan, Prakash Amboiram, Binu Ninan, Ashok Chandrasekharan, Saravanan Ramaswamy, Rajeswaran Rangasami


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. 


Etiology, India, MRI abnormalities, Neonatal seizures, Term

Full Text:



Silverstein FS, Jensen FE. Neonatal seizures. Ann Neurol. 2007;62:112-20.

Clancy RR. Summary proceedings from neurology group on neonatal seizures. Pediatrics. 2006;117(3):23-7.

Talebian A, Jahangiri M, Masoudi AN, Akbari H, Sadat Z. The etiology and clinical evaluations of neonatal seizures in Kashan, Iran. Iran J Child Neurol. Spring. 2015;9(2):29-35.

Volpe JJ. Neonatal seizures. In: Neurology of the Newborn. Philadelphia, PA: WB Saunders. 2001:178-214.

Hallberg B, Blennow M. Investigations for neonatal seizures. Semin Fetal Neonatal Med. 2013;18:196-201.

Ronen GM, Buckley D, Penney S, Streiner DL. Long-termprognosis in children with neonatal seizures: apopulation-based study. Neurology. 2007;69:1816-22.

Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R. Stewart outcome of seizures in term newborn infants. Pediatrics. 2006;117:1270-80.

Leth H, Toft PB, Herning M, Peitersen B, Lou HC. Neonatal seizures associated with cerebral lesions shown by magnetic resonanace imaging. Archives Disease Childhood. 1997;105-10.

Weeke LC, Groenendaal F, Toet MC, Benders MJ, Nievelstein RA, Rooij LG, et al. The aetiology of neonatal seizures and the diagnostic contribution of neonatal cerebral magnetic resonance imaging. Dev Med Child Neurol. 2015;57(3):248-56.

Garfinkle J, Shevell MI. Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol. 2011;15:222-9.

Ravindran M, Amborium P, Umamaheswari B, Ramani G, Ninan B. Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures? J Pediatr Neurosci. 2015;10(4):326-30.

Afsaneh S, Maryam D. Neonatal seizures in a rural Iranian district hospital: etiologies, incidence and predicting factors. Acta Medica Iranica. 2012;50(11):760-4.

Anand V, Pilli SK, Jayakrishnan D, Nair PMC. Neonatal seizures: our experience of incidence, etiology and outcome in a tertiary care centre. Indian J Child Health. 2014;1(2):39-43.

Pfister RH, Bingham P, Edwards EM, Horbar JD, Kenny MJ, Inder T, et al. The Vermont Oxford Neonatal Encephalopathy Registry: rationale, methods, and initial results. BMC Pediatr. 2012;12:84.

Tsakmakis M, Tooley J. Managing seizures in the neonatal period is there a UK consensus? Arch Dis Child Fetal Neonatal Ed. 2008;93:21-5.

Yıldız EP, Tatlı B, Ekici B, Eraslan E, Aydınlı N, Calışkan M, Ozmen M. Evaluation of etiologic and prognostic factors in neonatal convulsion. Pediatr Neurol. 2012;47(3):186-92.

Loman AM, Horst HJ, Lambrechtsen FA, Lunsing RJ. Neonatal seizures: aetiology by means of a standardized work-up. Eur J Paediatr Neurol. 2014;18(3):360-7.

Weeke LC, Van Rooij LG, Toet MC, Groenendaal F, de Vries LS. Neuroimaging in neonatal seizures. Epileptic Disord. 2015;17(1):1-11.

Vermeulen RJ, Fetter WP, Hendrikx L, Schie PE, Knaap MS, Barkhof F. Diffusion-weighted MRI in severe neonatal hypoxic ischaemia: the white cerebrum.Neuropediatrics. 2003;34(2):72-6.

Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: a population-based study. Neurology. 2007;69:1816-22.

Mastrangelo M, Lierde AV, Bray M, Pastorino G, Marini A, Mosca F. Epileptic seizures, epilepsy and epileptic syndromes in newborns: a nosological approach to 94 new cases by the 2001 proposed diagnostics scheme for people with epileptic seizures and with epilepsy. Seizure. 2005;14:304-11.

Verboon-Maciolek MA, Groenendaal F, Hahn CD. Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol. 2008;64:266-73.

Brouwer AJ, Groenendaal F, Koopman C, Nievelstein RJ, Han SK, Vries LS. Intracranial hemorrhage in full-term newborns: a hospital-based cohort study. Neuroradiology. 2010;52(6):567-76.

Whitby EH, Griffiths PD, Rutter S, Smith MF, Sprigg A, Ohadike P, et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet. 2004;363(9412):846-51.

Kersbergen KJ, Groenendaal F, Benders MJ, Vries LS. Neonatal cerebral sinovenous thrombosis: neuroimaging and long-term follow-up. J Child Neurol. 2011;26:1111-20.

Berfelo FJ, Kersbergen KJ, Ommen CH. Neonatal cerebral sinovenous thrombosis from symptom to outcome. Stroke. 2010;41:1382-8.

Osmond E, Billetop A. Neonatal seizures: magnetic resonance imaging adds value in the diagnosis and prediction of neurodisability. Acta Paediatrica. 2014;103:820-6.