Magnetic resonance imaging evaluation of intracranial abnormalities causing neonatal seizures in the post-COVID era: a cross-sectional study

Abstract

Background: Neonatal seizures are the most common neurological emergency in the neonatal period, representing the earliest sign of underlying cerebral pathology. Magnetic resonance imaging (MRI) has become the preferred imaging modality due to its superior soft-tissue contrast and ability to detect subtle structural abnormalities. In the post-COVID era, evolving patterns of neonatal neurological injury warrant renewed evaluation of MRI findings in this population. Objectives were to evaluate the spectrum of intracranial abnormalities on MRI in neonates presenting with seizures, and to determine the probable etiology based on MRI findings, in the post-COVID era.

Methods: Hospital-based cross-sectional observational study conducted over 18 months at a tertiary care centre. Forty-five consecutive neonates presenting with seizures underwent MRI brain within one week of onset, using a 1.5 Tesla scanner with T1W, T2W, FLAIR, diffusion-weighted imaging (DWI)/ apparent diffusion coefficient (ADC), and susceptibility-weighted imaging (SWI) sequences. Descriptive statistics were applied.

Results: MRI was abnormal in 77.8% (35/45) of neonates. Hypoxic-ischemic encephalopathy (HIE) was the most common etiology (40.0%), followed by intracranial haemorrhage (31.1%) and infective encephalitis pattern (20.0%). White matter involvement (55.6%) and diffusion restriction (40.0%) were the most frequent MRI findings. Bilateral involvement was present in 64.4%. Normal MRI was seen in 22.2%.

Conclusions: MRI demonstrates high diagnostic yield in neonatal seizures. HIE remains the leading cause; however, the relatively elevated proportions of intracranial haemorrhage and infective encephalitis patterns suggest evolving etiological trends in the post-COVID era. Early MRI with DWI and SWI is essential for timely diagnosis and targeted management.