Abstracts

Intracranial hemorrhage is the cause of neonatal seizures in 17% full term infants, and is more commonly seen following vaginal delivery assisted with forceps or vacuum extraction. However, only some infants with intracranial hemorrhage come to clinical attention. The etiology of the intracranial hemorrhage and the compartments involved determine the clinical presentation and outcome. Previous studies have identified that primary intraparenchymal hemorrhages are the site of bleeding resulting in the greatest proportion of physical and cognitive disabilities.
Right temporal lobe hemorrhage and resulting apneic seizures in a full term neonate has been reported previously, but there are very few cases reported in the literature. We report 2 neonates with apneic seizures as the initial manifestation of temporal lobe hemorrhage., Retrospective record review of 2 full term male neonates with no significant perinatal complications who presented with apneic seizures and temporal lobe hemorrhage., - One full term neonate presented on day 1 of life with episodes of apnea and desaturations. CT scan and MRI revealed a left temporal intraparencymal and extra-axial hemorrhage with surrounding edema and a 4mm left to right midline shift. On day 2, conjugate eye deviation to the right was associated with the apneic events requiring intubation and mechanical ventilation. EEG monitoring demonstarted multiple left hemispheric seizures, which clinically corelated with apnea and rightward eye devation. Seizures resolved after phenobarbital was loaded and there were no further apeneic events. No specific etiology for the intracranial bleed could be determined on further imaging and coagulation studies.
- The second neonate presented on day 1 of life with episodes of cyanosis unrelated to feeding and on day 2 had multiple episodes of apnea and desaturations requiring bagging. He appeared well between episodes. MRI demonstrated a posterior right temporal lobe hemorrhage, with an overlying subdural hematoma, as well as a right sigmoid sinus thrombosis.Evaluation for hypercoagulable states was unrevealing. A clinical diagnosis of apneic seizures was made, phenobarbital was loaded, no further apneic episodes occurred. Subsequent continuous EEG monitoring showed slowing in the right hemisphere., Apnea as the sole manifestation of a seizure is rare. It is important to recognize that although uncommon, full term neonates may present with apneic seizures as the initial manifestation of either left or right temporal lobe intracranial hemorrhage. Continous EEG monitoring should be considered in a full term neonate with unexplained apnea. Early detection of seizures can lead to investigation into the etiology of the hemorrhage, facilitate prompt management, which may help reduce the degree of ensuing neuro-developmenatl disablity.,