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Abnormal Neuroimaging is Associated with Early In-Hospital Seizures in Pediatric Abusive Head Trauma

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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 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.

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Acknowledgments

This study was supported by Davee Foundation (JG, MSW), the Lyndsey Whittingham Foundation (MSW), and the Medical Research Junior Board Foundation (MSW).

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Authors and Affiliations

  1. Division 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

    Joshua L. Goldstein, Natalie Kmytyuk & Mark S. Wainwright

  2. CARES Northwest, Emanuel Children’s Hospital, Portland, OR, USA

    Daniel Leonhardt

  3. Childrens Medical Research Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Deli Wang

  4. Department of Medical Imaging, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Francine Kim

  5. Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mark S. Wainwright

Authors
  1. Joshua L. Goldstein
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  2. Daniel Leonhardt
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  3. Natalie Kmytyuk
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  4. Francine Kim
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  5. Deli Wang
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  6. Mark S. Wainwright
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Correspondence to Joshua L. Goldstein.

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Goldstein, J.L., Leonhardt, D., Kmytyuk, N. et al. Abnormal Neuroimaging is Associated with Early In-Hospital Seizures in Pediatric Abusive Head Trauma. Neurocrit Care 15, 63–69 (2011). https://doi.org/10.1007/s12028-010-9468-5

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  • DOI: https://doi.org/10.1007/s12028-010-9468-5

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