Related Experiment Video
Updated: Feb 12, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Seizure Severity Is Correlated With Severity of Hypoxic-Ischemic Injury in Abusive Head Trauma
Andra L Dingman1, Nicholas V Stence2, Brent R O'Neill3
1Department of Pediatrics, Division of Child Neurology, University of Colorado Anschuts Medical Campus, Aurora, Colorado.
Insights
Electrographic seizures and hypoxic-ischemic brain injury are frequent in abusive head trauma cases. Younger age and greater hypoxic-ischemic injury severity correlate with increased seizure risk in these children.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Forensic Pathology
Background:
- Abusive head trauma (AHT) is a significant cause of pediatric brain injury.
- Characterizing the neurological manifestations of AHT is crucial for diagnosis and management.
- Hypoxic-ischemic injury and seizures are potential consequences of AHT.
Purpose of the Study:
- To characterize the occurrence and patterns of hypoxic-ischemic injury and seizures in children with AHT.
- To identify factors associated with the presence and severity of these neurological injuries.
Main Methods:
- Retrospective study of 58 children with moderate to severe traumatic brain injury due to AHT.
- Continuous electroencephalograms (EEGs) and magnetic resonance imaging (MRI) were utilized and scored.
- Analysis of associations between age, injury severity, and seizure occurrence.
Main Results:
- Seizures (51.2%) and hypoxic-ischemic injury (77.4%) were highly prevalent in the cohort.
- Younger age (median 4.5 months) and increased hypoxic-ischemic injury severity were significantly associated with seizures.
- A correlation was found between hypoxic-ischemic injury severity and seizure burden (r=0.61, P<0.001).
Conclusions:
- Electrographic seizures are common in AHT, necessitating continuous EEG monitoring in suspected cases.
- Hypoxic-ischemic brain injury severity correlates with seizure burden and may evolve over time.
- Reimaging with MRI is recommended for children with high seizure burden to assess evolving hypoxic-ischemic injury.
Background:
The objective of this study was to characterize hypoxic-ischemic injury and seizures in abusive head trauma.
Methods:
We studied 58 children with moderate or severe traumatic brain injury due to abusive head trauma. Continuous electroencephalograms and magnetic resonance images were scored.
Results:
Electrographic seizures (51.2%) and hypoxic-ischemic injury (77.4%) were common in our cohort. Younger age was associated with electrographic seizures (no seizures: median age 13.5 months, interquartile range five to 25 months, versus seizures: 4.5 months, interquartile range 3 to 9.5 months; P = 0.001). Severity of hypoxic-ischemic injury was also associated with seizures (no seizures: median injury score 1.0, interquartile range 0 to 3, versus seizures: 4.5, interquartile range 3 to 8; P = 0.01), but traumatic injury severity was not associated with seizures (no seizures: mean injury score 3.78 ± 1.68 versus seizures: mean injury score 3.83 ± 0.95, P = 0.89). There was a correlation between hypoxic-ischemic injury severity and seizure burden when controlling for patient age (rs=0.61, P < 0.001). The ratio of restricted diffusion volume to total brain volume (restricted diffusion ratio) was smaller on magnetic resonance imaging done early (median restricted diffusion ratio 0.03, interquartile range 0 to 0.23 on magnetic resonance imaging done within two days versus median restricted diffusion ratio 0.13, interquartile range 0.01 to 0.43 on magnetic resonance imaging done after two days, P = 0.03).
Conclusions:
Electrographic seizures are common in children with moderate to severe traumatic brain injury from abusive head trauma, and therefore children with suspected abusive head trauma should be monitored with continuous electroencephalogram. Severity of hypoxic-ischemic brain injury is correlated with severity of seizures, and evidence of hypoxic-ischemic injury on magnetic resonance imaging may evolve over time. Therefore children with a high seizure burden should be reimaged to evaluate for evolving hypoxic-ischemic injury.
Related Concept Videos
02:20Correlations
01:27Correlation and Causation
Correlation versus Causation
If the dependent variable increases or decreases when the independent variable increases, there is a positive or negative...
01:15Drug Abuse and Addiction: Pharmacological Phenomena
01:09Correlation
Two variables, for example, a and b, are said to be positively correlated if both variables move in the same direction. In other words, a positive correlation exists between two variables, a and b, if:
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:19Muscles that Move the Head
The bilateral sternocleidomastoid, or SCM, and the suprahyoid and infrahyoid muscles are significant head flexors. The SCM muscles originate at the sternum and clavicle and attach to the mastoid process of the temporal bone. The SCM contracts bilaterally to bend the head forward, whereas...