- Leading cause of neonatal seizures in full-term infants.
- This diagnosis should never be one of exclusion.
- Data supporting this diagnosis (history of prolonged labor, perinatal depression, prolonged resuscitation) should be obtained and documented.
- Second most common cause of neonatal seizures in full-term infants.
- Most common presentation is right-sided clonic seizures due to infarction in the left middle cerebral artery territory.
- Cerebral vein thromboses can lead to venous infarcts.
- In term infants, subarachnoid hemorrhage is more associated with subsequent seizure than subdural hemorrhage.
- Infratentorial subdural hemorrhages require urgent evaluation due to risk of brainstem compression.
- In preterm infants, intraventricular hemorrhage is the most common type of ICH (see below).
Infections of the CNS
- Can occur in utero (CMV, toxoplasmosis) or perinatally (herpes simplex, bacterial meningitis with GBS or Escherichia coli being most common).
- Prognosis can be very grim.
- Transient causes (hypoglycemia, hypocalcemia, hyponatremia); see Chapter 34 for further information.
- Inborn errors of metabolism (pyridoxine dependency, nonketotic hyperglycinemia, urea cycle defects, glutaric aciduria (type II), maple syrup urine disease, organic acidurias, cofactor deficiencies, mitochondrial defects , Zellweger Syndrome).
- Defects of neuronal migration (heterotopias).
- Defects of neuronal organization (polymicrogyria).
- Cerebral malformation (holoprosencephaly).
- Usually will display associated dysmorphic features on physical examination.