İlk Kez Afebril Nöbet Geçiren Çocuklarda Nörogörüntüleme Bulguları

Amaç: İlk kez afebril nöbet geçiren çocuklarda, anormal nörogörüntüleme bulgularını öngörmede, başta klinik bulgularolmak üzere etkili olabilecek değişkenlerin araştırılması amaçlandı.Gereç ve Yöntemler: Çalışmamız hastane etik kurul onayı alınarak yapıldı. Ocak 2016 ile Ocak 2018 tarihleri arasında,ilk kez afebril nöbet geçirmiş, beyin bilgisayarlı tomografisi (BT) ve/veya manyetik rezonans görüntülemesi (MRG) yapılmışardışık 64 hastanın (39 erkek, 25 kız, ortalama yaş 7.5±5.7 yıl, yaşları 0.1–17 yıl arasında), medikal ve görüntülemebulguları geriye dönük tarandı. Kategorik-sayısal değişkenler Ki-kare, Fisher, t-testi ile analiz edildi ve lojistik regresyonanalizi yapıldı.Bulgular: Hastaların tamamına BT çekilmiş, %70.3’üne MRG yapılmıştı. Hastaların % 26.6’sında BT ve MRG’deanormal bulgular, %21.9’unda klinik olarak önemli anormal bulgular saptandı. Nöbet sayısının birden fazla olması(p=0.031), nöbet açısından risk faktörünün (p=0.025) ve anormal nörolojik muayenenin varlığı (p=0.037) ile klinik olarakönemli anormal nörogörüntüleme bulguları arasında anlamlı ilişki saptandı. Lojistik regresyon analizinde, anormalnörogörüntüleme bulgularını öngörmede, erkek cinsiyet (p=0.015), 3 yaştan büyük olmak (p=0.038) ve nöbet açısındanrisk faktörünün varlığı (p=0.036) anlamlı bulundu. Hastaların % 62.5’i epilepsi, % 6.3’ü santral sinir sistemi enfeksiyonutanısı almıştı. Hastaların % 23.4’ünün nöbeti, ortalama 1 yıllık takip süresince tekrarlamamış ve tek afebril nöbet olarakdeğerlendirilmiş, % 7.8’inde acil müdahele gerektiren anormallik saptanmıştı (kitle, kanama, iskemi).Sonuç: İlk kez afebril nöbet geçiren çocuklarda, nöbet açısından risk faktörünün ve anormal nörolojik muayeneninvarlığında, nöbet sayısının birden fazla olması durumunda yapılan nörogörüntüleme bilgilendirici olmaktadır. BT, yerkaplayan kitle ve kanama gibi acil müdahale gerektiren lezyonları göstermede olguların çoğunda yeterlidir. Klinik olarakönemli anormal bulguları göstermede MRG, uygun şartlarda çocuklarda tercih edilmesi gereken görüntüleme yöntemidir

Neuroimaging Findings in Children with New-Onset Afebrile Seizure

Objective: To evaluate the predictors of abnormal neuroimaging findings in children with new-onset afebrile seizure. Material and Methods: The study was approved by the local ethics committee. We retrospectively reviewed the medical and imaging records of 64 consecutive patients (male/female=39/25; mean age±standard deviation=7.5±5.7 years, age ranges 0.1–17 years) who had brain computed tomography (CT) and/or magnetic resonance imaging (MRI) between January 2016 and January 2018. Categorical and numerical variables were analyzed by Chi-square, Fisher, t-test and logistic regression analysis was performed. Results: CT was performed in all patients and 70.3% of the patients underwent MRI. CT and MRI findings were abnormal in 26.6% of the patients. Clinically significant abnormal neuroimaging findings were found in 21.9% of the patients. There were significant relationships among the history of presence of risk factors for seizure (p=0.025), more than one seizure (p=0.031), abnormal neurological examination (p=0.037) and clinically significant abnormal neuroimaging findings. In predicting abnormal neuroimaging findings in logistic regression analysis, male gender (p=0.015), age over 3 years (p=0.038) and presence of risk factor for seizure (p=0.036) were found to be significant. Forty patients (62.5%) had the diagnosis of epilepsy and 6.3% of the patients had the diagnosis of central nervous system infection. 23.4% of the patients’ seizures did not recur over a 1-year follow-up period, so they evaluated as a single afebrile seizure and 7.8% of the patients had an emergency intervention requiring abnormalities (mass lesion, bleeding, ischemia) on neuroimaging. Conclusion: Neuroimaging is informative in children with new-onset afebrile seizure who have a risk factor for seizure, abnormal neurological examination findings and multiple seizures. CT is sufficient to show lesions in most of cases that require urgent intervention such as mass lesion and intracranial hemorrhage. MRI should be preferred in children under appropriate conditions in showing clinically important abnormal findings.

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