Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Clinical and Imaging Findings of Neonatal Seizures Presenting as Diffuse Cerebral White Matter Abnormality on Diffusion-Weighted Imaging without any Structural or Metabolic Etiology

확산강조영상에서 미만성 대뇌 백질의 이상을 보이는 신생아 경련 환자에서 구조적 이상이나 대사와 관련된 원인이 없을 경우 임상적 소견과 영상 소견의 특징

  • Maeran Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Jae-Yeon Hwang (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Yeoun Joo Lee (Department of Pediatrics, Pusan National University Children's Hospital, School of Medicine, Pusan National University) ;
  • Yong-Woo Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Shin Yun Byun (Department of Pediatrics, Pusan National University Children's Hospital, School of Medicine, Pusan National University) ;
  • Yun-Jin Lee (Department of Pediatrics, Pusan National University Children's Hospital, School of Medicine, Pusan National University) ;
  • Jeong A Yeom (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Ung Bae Jeon (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Ki Seok Choo (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Kyung Jin Nam (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Storm Nicholas Shaun Reid (College of Creative Human Resource, School of Liberal Arts Education, Kyungsung University)
  • 김매란 (양산부산대학교병원 영상의학과) ;
  • 황재연 (양산부산대학교병원 영상의학과) ;
  • 이연주 (부산대학교 의과대학 양산부산대학교 어린이병원 소아청소년과) ;
  • 김용우 (양산부산대학교병원 영상의학과) ;
  • 변신연 (부산대학교 의과대학 양산부산대학교 어린이병원 소아청소년과) ;
  • 이윤진 (부산대학교 의과대학 양산부산대학교 어린이병원 소아청소년과) ;
  • 염정아 (양산부산대학교병원 영상의학과) ;
  • 전웅배 (양산부산대학교병원 영상의학과) ;
  • 추기석 (양산부산대학교병원 영상의학과) ;
  • 남경진 (양산부산대학교병원 영상의학과) ;
  • Received : 2019.04.05
  • Accepted : 2020.02.21
  • Published : 2020.11.01
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Abstract

Purpose Some patients with neonatal seizures show diffuse, symmetric diffusion-restricted lesions in the cerebral white matter. The aim of this study was to describe clinical and imaging findings of patients with neonatal seizures who had diffuse, symmetric diffusion-restricted lesions without any structural or metabolic etiology. Materials and Methods A total of 56 neonates aged less than 1 week underwent brain magnetic resonance imaging (MRI) for evaluation of seizures from November 2008 to February 2017. After excluding 43 patients, 13 patients showed diffuse white matter abnormality on diffusion-weighted imaging. Initial and follow-up clinical and MRI findings were analyzed retrospectively. Results All 13 patients were born at full term. Among the ten patients who underwent a stool test for viruses, six were positive for rotavirus and one for astrovirus. MRI revealed diffuse, symmetric diffusion-restricted lesions distributed along the cerebral white matter, thalami, and midbrain variably. Conclusion Diffuse, symmetric diffusion-restricted lesions involving the cerebral white matter can be seen in patients with neonatal seizures without any structural or metabolic etiology. Rotavirus is commonly but not exclusively detected in these patients. Nevertheless, viral infection-associated encephalopathy should be considered for patients with characteristic clinical and MRI findings.

목적 본 연구는 신생아 경련 환자에서 구조적 이상이나 대사로 인한 원인이 없으면서, 확산강조영상에서 미만성 대뇌 백질의 이상을 보이는 경우의 임상적 소견과 영상 소견의 특징을 기술하고자 한다. 대상과 방법 2008년 11월에서 2017년 2월 사이에 경련에 대한 평가를 위해 56명의 생후 1주 미만의 신생아가 뇌 자기공명영상을 시행하였다. 이중 33명을 제외한 23명중, 13명에서 확산강조영상에서 미만성 대뇌 백질 이상을 보였다. 내원 시 임상 소견, 자기공명영상 소견, 추적검사 결과에 대해 후향적으로 분석하였다. 결과 확산제한을 보인 13명의 환아는 모두 만기 분만 환아였다. 대변 바이러스 검사를 시행한 10명 중 6명은 로타바이러스, 한 명은 아스트로 바이러스가 검출되었다. 확산 제한은 대뇌 백질, 시상, 중뇌에 걸쳐 다양하게 분포하였다. 결론 신생아 경련 환자에서 구조적 이상이나 대사로 인한 원인이 없으면서, 확산강조영상에서 미만성 대뇌 백질의 이상을 보이는 경우, 로타바이러스가 검출되는 경우가 흔히 있었다. 따라서 이러한 임상적, 영상의학적 소견을 보일 때, 바이러스 감염과 관련된 뇌증의 가능성을 고려할 필요가 있을 것으로 판단된다.

Keywords

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