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Periodic lateralized epileptiform discharges (PLEDs) as early indicator of stroke in full-term newborns
Insights
Periodic lateralized epileptiform discharges (PLEDs) on EEG indicate neonatal convulsions. These EEG abnormalities, seen in infants with normal ultrasounds, correlated with cerebral infarction found via MRI.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Pediatric epilepsy
Background:
- Neonatal convulsions are a critical concern in infant neurology.
- Electroencephalography (EEG) is crucial for diagnosing seizure disorders in neonates.
- Cerebral infarction can manifest in newborns, posing significant neurological risks.
Observation:
- Two infants presented with neonatal convulsions and subsequent EEG abnormalities.
- Periodic lateralized epileptiform discharges (PLEDs) were observed on EEG shortly after seizure onset.
- Initial cranial ultrasounds appeared normal in both neonates.
Findings:
- Magnetic Resonance Imaging (MRI) revealed cerebral infarction in both infants.
- In one case, the MRI lesion location corresponded with EEG abnormalities.
- The second infant's MRI showed a basal ganglia lesion, also linked to PLEDs.
Implications:
- EEG findings, particularly PLEDs, can precede detectable structural abnormalities on ultrasound in neonatal convulsions.
- MRI is essential for identifying cerebral infarction underlying neonatal seizures.
- Understanding the correlation between EEG patterns and specific lesion locations aids in diagnosing and managing neonatal neurological conditions.
Abstract:
We report on periodic lateralized epileptiform discharges (PLEDs) on EEG in two infants with neonatal convulsions. In both neonates, the EEG abnormalities were seen soon after the onset of seizures, at a time when cranial ultrasound scans were thought to be normal. Subsequent Magnetic Resonance Imaging scans demonstrated cerebral infarction in both patients. In one case, the localisation of the lesion on MRI was concordant with that of the EEG abnormalities, as usually observed in adults with focal lesions. The other infant showed similar EEG abnormalities, but her MRI showed a localised lesion in the basal ganglia, which has also been reported to be involved in the genesis of these abnormalities.