An Unusual Cause of Neonatal Seizures in a Newborn Infant
ABSTRACT. Neonatal seizures in the neonatal period
are symptoms of numerous underlying disorders of the
neonate. We present a case in which neonatal seizures
due to cerebral infarction led to a diagnosis in the
mother.
Neonatal convulsions caused by cerebral artery thrombosis is relatively rare in the neonatal period and is often
secondary to indwelling intravascular catheters that
cause thromboembolism, but may be associated with
many conditions.1
Cerebral artery thrombosis in newborns, in which
antiphospholipid antibodies (APA) were found in the
mother, has been described in three case reports.2,3 Two
of these premature infants were born with other risk
factors for thrombosis. APA could not be identified in
any of these three infants. In the two cases reported by
Silver et al3 the diagnosis was made several months
after birth.
This case is unique in the fact that no other risk factors
for thrombosis could be identified to explain the infarction, and that APA were found in the offspring of an
apparently healthy mother. Whether the prior fetal death
was caused by APA remains unclear. The finding of
lupus anticoagulant in her child led to the diagnosis of
antiphospholipid antibody syndrome in her. We believe
that in case of cerebral artery thrombosis in a neonate,
with no trivial cause such as an indwelling catheter or
sepsis, both mother and infant should be tested for presence of APA, even when the mother seems healthy.
Pediatrics 1997;100(4). URL: http://www.pediatrics.org/
cgi/content/full/100/4/e8; neonate, cerebral infarction, maternal antiphospholipid syndrome.

(P90), and had a head circumference of 35 cm (P50). A few
hours after birth, he started to have multiple subtle seizures
manifested by repetitive blinking, smacking movements,
right-sided twitching of the head and ipsilateral hand and foot.
None of the seizures lasted more than 3 minutes. Neurologic
examination was otherwise normal. Hematological evaluation,
glucose, and electrolytes were normal. There were no signs of
an intrauterine infection. An electroencephalogram showed an
intermittent irritative disturbance in the left hemisphere.
An ischemic left-middle cerebral artery infarct with a minor
hemorrhage could be identified on magnetic resonance imaging
(MRI) (Fig 1). On additional magnetic resonance angiography no
vascular aberrations of the large vessels were seen. Duplex of the
carotid arteries and transcranial Doppler did not show any abnormalities. Coagulation studies revealed lupus anticoagulant (LAC)
immunoglobulin G (IgG) presence, the titer being 18.9 GPL
units/mL (normal #10 GPL units/mL). Anticardiolipin antibody
was negative. Detection of LAC and anticardiolipin IgG was performed according to the methods described by Brandt et al.1
Activated partial thromboplastin time and prothrombin time were
both normal. Protein S, protein C activity, and antithrombin IIIactivity were normal for age. Factor VLeiden was absent. An electrocardiogram showed no signs of heart blockage. His mother was
additionally tested (6 days later) for antiphospholipid antibodies
(APA) and she seemed to have an anticardiolipin IgG titer of 20
GPL units/mL (normal #10 GPL units/mL); LAC was negative.
The child was given phenobarbital on day 4. The convulsions
were not seen after day 5, and no other problems were encountered. He was discharged on day 8, and is still doing well. After 1
month, he became LAC-negative. At the age of 3 months, the MRI
showed an old infarct of the left middle cerebral artery with some
cortical atrophy (Fig 2). At neurologic examination at the age of 1
year, no asymmetry in motor function was found and there were
no signs of developmental delay.

ABBREVIATIONS. MRI, magnetic resonance imaging; LAC, lupus
anticoagulant; IgG, immunoglobulin G; APA, antiphospholipid
antibodies.

COMMENTS

N

eonatal seizures in the neonatal period are
symptoms of numerous underlying disorders of the neonate. We present a case in
which neonatal seizures due to cerebral infarction
led to a diagnosis in the mother.
CASE REPORT

A 3-day-old male infant was referred to the neonatology
ward because of convulsions. He was born at 39-weeks gestation, after a normal vertex delivery. His 25-year-old mother had
a history of one intrauterine fetal death at 20 weeks. This
pregnancy had been uncomplicated, although his mother had
noticed numerous periods of subtle movements in the last 4
weeks of her pregnancy that felt different from normal fetal
movements or uterine contractions and never lasted more than
2 minutes. The infant weighed 3500 g (P50), was 54 cm long

Received for publication Dec 2, 1996; accepted Feb 15, 1997.
Reprint requests to (T.W.d V.) Department of Pediatrics, Medisch Centrum
Leeuwarden, Mr PJ Troelstraweg 78, 8917 CD Leeuwarden, The Netherlands.
PEDIATRICS (ISSN 0031 4005). Copyright © 1997 by the American Academy of Pediatrics.

In the neonatal period, convulsions are mostly attributable to perinatal asphyxia, metabolic derangements,
or infections.2 Thromboembolism is a relatively rare
cause of convulsions in the newborn and is often secondary to indwelling intravascular catheters,3 but may
be associated with many conditions. Thromboembolism in newborns of LAC-positive mothers has been
described.4,5 Affected women characteristically have
poor pregnancy outcomes that may be improved with
prednisone and low-dose aspirin treatment.6 Zurgil7
showed transplacental transfer of APA in 18 pregnant
women, but in none of the cases could clinical manifestations of APA syndrome be detected. Titers of APA
in affected women may fall after pregnancy. This may
explain why anticardiolipin antibodies, and not LAC,
could be detected in the mother at the time of determination.
Cerebral artery thrombosis in newborns, in which
APA were found in the mother, has been described in
three case reports.8,9 Two of these premature infants
were born with other risk factors for thrombosis. In
none of the three cases could APA be identified in the
infant. In the two cases reported by Silver et al9 the
diagnosis was made several months after birth.
This case is unique in the fact that no other risk

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PEDIATRICS Vol. 100 No. 4 October 1997
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Fig 1. MRI image of the brain made 1 week
postpartum showing edema of the left hemisphere with a small hemorrhage, corresponding
with a left middle cerebral artery infarction.

Fig 2. MRI image made at 3 months after birth
showing focal cortical atrophy of the left parietal lobe, suggesting an old infarction of the left
middle cerebral hemisphere.

factors for thrombosis could be identified to explain
the infarction and that APA were found in the offspring of an apparently healthy mother. Whether the
prior fetal death was caused by APA remains unclear. The finding of LAC in her child led to the
2 of 3

diagnosis of antiphospholipid antibody syndrome in
her. This is comparable with diagnosing systemic
lupus erythematosus in mothers of children with
Ro-SSA positive congenital heart block or neonatal
thrombocytopenia.10

NEONATAL SEIZURES IN A NEWBORN INFANT
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We believe that in the case of thromboembolism in
a neonate, with no trivial cause such as an indwelling
catheter or sepsis, both mother and infant should be
tested for the presence of APA, even when the
mother seems healthy.
O. L. de Klerk, MD
T. W. de Vries, MD
Department of Pediatrics
Leeuwarden Medical Centre
Leeuwarden, The Netherlands
L. G. F. Sinnige, MD
Department of Neurology
Leeuwarden Medical Centre
Leeuwarden, The Netherlands
REFERENCES
1. Brandt JT, Barna LK, Triplett DA. Laboratory identification of lupus
anticoagulant: results of the second international workshop for identification of lupus anticoagulant. Thromb Haemost. 1995;74:1597–1603
2. Hill A, Volpe JJ. Neurologic disorders. In: Avery GB, Fletcher MA,

MacDonald MG, eds. Neonatology: Pathophysiology and Management of the
Newborn. 4th ed. Philadelphia, PA: JB Lippincott Company; 1994:
1119 –1120
3. Kotlarek F, Thron A, Weber U, et al. Der Schlaganfall beim Kind:
Ätiologie, Differentialdiagnose, sinnvolle Diagnostik und therapeutische Möglichkeiten. Klin Padiatrie. 1993;205:332–339
4. Sheridan-Pereira M, Porreco RP, Hays T, et al. Neonatal aortic thrombosis associated with the lupus anticoagulant. Obstet Gynecol. 1988;71:
1016 –1018
5. Finazzi G, Cortelazzo S, Viero P, et al. Maternal lupus anticoagulant and
fatal neonatal thrombosis. Thromb Haemost. 1987;87:238
6. Lubbe WF, Butler WS, Palmer SJ, et al. Lupus anticoagulant in pregnancy. Br J Obstet Gynaecol. 1984;91:357
7. Zurgil N, Bakimer R, Tincani A, et al. Detection of anti-phospholipid
and anti-DNA antibodies and their idiotypes in newborns of mothers
with anti-phospholipid syndrome and SLE. Lupus. 1993;2:233–237
8. Tabbut S, Griswold WR, Ogino, MT, et al. Multiple thrombosis in a
premature infant associated with maternal phospholipid antibody syndrome. J Perinatol. 1994;14:66 –70
9. Silver RK, MacGregor J, Pasternak JF, et al. Fetal stroke association
with elevated anticardiolipin antibodies. Obstet Gynecol. 1992;80:
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10. Esscher E, Scott JS. Congenital heart block and maternal systemic lupus
erythematosus. Br Med J. 1979;1:1235

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An Unusual Cause of Neonatal Seizures in a Newborn Infant
O. L. de Klerk, T. W. de Vries and L. G. F. Sinnige
Pediatrics 1997;100;e8
DOI: 10.1542/peds.100.4.e8
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and
trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove
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An Unusual Cause of Neonatal Seizures in a Newborn Infant
O. L. de Klerk, T. W. de Vries and L. G. F. Sinnige
Pediatrics 1997;100;e8
DOI: 10.1542/peds.100.4.e8

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/100/4/e8.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1997 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Mc Master University on March 18, 2015