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Abnormal neuroimaging is associated with early in-hospital seizures in pediatric abusive head trauma
Joshua L Goldstein1, Daniel Leonhardt, Natalie Kmytyuk
1Division of Neurology no. 51, Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza, Chicago, IL 60614, USA. jgoldstein@childrensmemorial.org
Insights
Abusive head trauma (AHT) in children frequently causes seizures during hospitalization. Specific brain imaging findings help identify children at higher risk for these seizures and predict outcomes.
Area of Science:
- Pediatric neurology
- Child abuse research
- Neuroradiology
Background:
- Abusive head trauma (AHT) is a significant concern in pediatrics.
- The frequency, risk factors, and outcomes associated with seizures in AHT are not well understood.
Purpose of the Study:
- To determine the incidence of in-hospital seizures following AHT.
- To identify factors associated with an increased risk of seizures in AHT patients.
- To explore the association between seizures and patient outcomes.
Main Methods:
- Retrospective chart review conducted at a single tertiary care pediatric hospital.
- Analysis of 54 identified cases of AHT.
- Correlation of clinical seizure occurrence with neuroimaging findings (CT and MRI) and patient outcomes.
Main Results:
- 33% of AHT patients experienced clinical seizures within the first week of admission.
- CT findings like midline shift, cerebral edema, and loss of gray-white differentiation were linked to seizures.
- MRI findings including midline shift, edema, infarction, and restricted diffusion were associated with seizures.
- Presenting symptoms (seizures, altered mental status) and imaging abnormalities correlated with short-term outcomes.
Conclusions:
- Neuroradiologic findings are crucial in identifying children at elevated risk for seizures (clinical and subclinical) post-AHT.
- Seizures are a common occurrence during the initial hospitalization for AHT.
Background:
Abusive head trauma (AHT) is a common condition in children. Little is known in this condition regarding the frequency of seizures, the factors associated with increased risk of seizures, or the association of seizures with outcome. We sought to determine frequency and risks for in-hospital seizures after AHT.
Methods:
This was a single-center, retrospective chart review study at a 270 bed tertiary care referral pediatric hospital.
Results:
A total of 54 cases of AHT were identified during the study period. During the first week following hospital admission, 33% of patients were observed to have clinical seizures. The occurrence of clinical seizures after admission was associated with findings on initial CT including midline shift, cerebral edema, and loss of gray white differentiation. MRI findings associated with clinical seizures after admission included midline shift, cerebral edema, infarction, and restricted diffusion. The presenting complaint of seizures or acute mental status changes well as a variety of abnormal imaging findings including gray white blurring, infarction, and edema were associated with short-term outcomes.
Conclusions:
Specific neuroradiologic findings identify children at greater risk for seizures, both clinical and subclinical, following AHT. Clinical and subclinical seizures are common in the initial hospitalization for AHT.