Abnormal neuroimaging is associated with early in-hospital seizures in pediatric abusive head trauma

Joshua L. Goldstein*, Daniel Leonhardt, Natalie Kmytyuk, Francine Kim, Deli Wang, Mark S. Wainwright

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

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 shortterm 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.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalNeurocritical Care
Volume15
Issue number1
DOIs
StatePublished - Aug 2011

Keywords

  • Cerebral edema
  • Child abuse
  • Electroencephalography
  • Seizure
  • Status epilepticus

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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