A 2 days old premature neonate develops GTCS. What is the investigation done to diagnose the pathology? (AIIMS November 2013, May 2013)
Ans. a. Transcranial ultrasound (Ref: http://www.ncbi.nlm.nih.gov/books/NBK2599)'Cranial ultrasonography is the main imaging modality of premature neonates and well suited for the study of neonates in general. It is performed at the bedside and provides effective assessment of ventricular size and other fluid-containing lesions as well as effective viewing of haemorrhagic and ischaemic lesions and their evolution.'- style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> NBK2599/Neonatal SeizuresNeonatal seizures or neonatal convulsions are epileptic fits occurring from birth to the end of the neonatal periodQ.The neonatal period is the most vulnerable of all periods of life for developing seizures, particularly in the first 1-2 days to the first week from birthQ.Etiology:MC cause is hypoxic-ischaemic encephalopathy, responsible for 80% of all seizures in the first 2 days of lifeQ.Brain damage due to prenatal distress and malformations of cortical developmentQ.Intracranial haemorrhage and infarction, strokePrenatal and neonatal infectionsAcute metabolic disturbances such as electrolyte and glucose abnormalitiesInborn errors of metabolismPathophysiologyEarly postnatal development time is a period of increased susceptibility to seizures in relation to other ages, due to a combination of factors specific to the developing brain that enhance excitation and diminish inhibitionQ.Diagnostic Procedures:Polygraphic video-EEG recording of suspected events is probably mandatory for an incontrovertible seizure diagnosis.Brain Imaging:Cranial ultrasonograghy is the main imaging modality of premature neonates and well suited for the study of neonates in generalQ. It is performed at the bedside and provides effective assessment of ventricular size and other fluid-containing lesions as well as effective viewing of haemorrhagic and ischaemic lesions and their evolution.CT brain scan is often of secondary or adjunctive importance to ultrasound. Last-generation CT brain scan images are of high resolution, can be generated within seconds and can accurately detect haemorrhage, infarction, gross malformations and ventricular and other pathological conditions.MRl is much superior for abnormalities of cortical development, used for the detection of structural abnormalities such as malformations of cortical development, intracranial haemorrhage, hydrocephalus and cerebral infarction.
Transcranial ultrasound
CT Head
MRI brain
X-ray
C.V.S.