Early Magnetic Resonance Imaging as a Screen for Sturge–Weber Syndrome‐Related Seizures in Infants With Upper‐Facial Capillary Malformations

Background Upper‐facial capillary malformation (CM) may be concerning for Sturge–Weber syndrome (SWS). Use of screening magnetic resonance imaging (MRI) for neuroradiographic findings of SWS is controversial. MRI within a few months of life may allow for prompt reassurance, preventive treatments, and avoidance of contrast and sedation. However, false‐negative MRI before 1 year of age has been reported. We examined the ability of early MRI to predict seizure development in infants with upper‐facial CM. Methods Infants with forehead or temple CM presenting to the Sturge–Weber Clinic at Boston Children's Hospital from 2012 to 2022 were identified. The records were reviewed for clinical features and for findings from MRI performed before 1 year of age (MRI 1) and repeated around or after 2 years of age (MRI 2). Patients with seizures before MRI 1 or with a diagnosis of nevus simplex were excluded. Results Thirty‐three patients with forehead or temple CM without seizures before MRI 1 were identified. MRI 1 was abnormal in 20/33 and normal in 13/33. Fourteen of 20 patients with abnormal MRI 1 developed seizures. Of the 13 patients with normal MRI 1, 11 underwent MRI 2. In patients with MRI 2, 3/11 developed SWS‐related abnormalities, but none (0/11) developed seizures. The remaining 2 patients with normal MRI 1 also did not develop seizures. Mean follow‐up age was 6.1 years (0.83–15 years). Conclusion Early, high‐quality non‐contrast 3 T MRI may screen for seizure development in infants with upper‐facial CM.