List common etiologies of neonatal seizures and a key imaging choice in the first hours of life.

• A. Hypoxic-ischemic encephalopathy, intracranial hemorrhage, infection, metabolic disorders; MRI is a key imaging modality but CT may be used emergently if hemorrhage suspected
• B. Neonatal seizures due to epilepsy; Ultrasound is key
• C. Only hypoglycemia causes neonatal seizures; X-ray
• D. Neonatal seizures from trauma; PET is key

Answer: (A)

Neonatal seizures typically reflect an acute brain disturbance around birth, with the most common causes being hypoxic-ischemic injury from perinatal asphyxia, intracranial hemorrhage, infection, and metabolic disorders such as severe hypoglycemia or electrolyte problems. Perinatal hypoxia can lead to hypoxic-ischemic encephalopathy, a frequent and important cause of seizures in newborns. Intracranial bleeding, including intraventricular or subdural hemorrhages, is another key culprit in this age group. Infections like neonatal sepsis or meningitis can irritate the developing brain and provoke seizures, while metabolic derangements can also trigger them early after birth.

For imaging in the first hours of life, MRI is the preferred modality for a comprehensive assessment of brain injury and its causes, because it provides superior soft-tissue detail and diffusion imaging to detect acute injury. If there is urgent concern for hemorrhage, CT is used emergently since it can rapidly identify bleeding and guide immediate management. While ultrasound can offer quick bedside information, it doesn’t replace MRI or CT for the full etiologic evaluation.