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Mariajoseph FP, Sagar P, Muthusamy S, Amukotuwa S, Seneviratne U. Seizure-induced reversible MRI abnormalities in status epilepticus: A systematic review. Seizure 2021; 92:166-173. [PMID: 34525432 DOI: 10.1016/j.seizure.2021.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 12/29/2022] Open
Abstract
In the context of status epilepticus (SE), seizure-induced reversible MRI abnormalities (SRMA) can be difficult to differentiate from epileptogenic pathologies. To identify patterns and characteristics of SRMA, we conducted a systematic review in accordance with the Preferred Items Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included publications describing patients (a) presenting with status epilepticus, (b) exhibiting seizure-induced MRI abnormalities, (c) who demonstrated complete resolution of MRI abnormality at follow-up, and (d) who had availability of descriptive MRI results. A total of 49 cases from 19 publications fulfilled our eligibility criteria. Signal abnormalities were most frequently reported on T2-weighted sequences followed by diffusion-weighted and fluid-attenuated inversion recovery imaging. Both unilateral and bilateral SRMA were reported. Unilateral EEG abnormalities were often associated with ipsilateral SRMA. The signal changes appeared during the ictus itself in some subjects whilst the median time to SRMA appearance and resolution were 24 h and 96.5 days, respectively. Based on the distribution of reversible signal alterations, we identified five 'composite patterns': (1) predominant cortical (with or without subcortical, leptomeningeal or thalamic involvement), (2) hippocampal (with or without cortical, subcortical, leptomeningeal, or thalamic involvement), (3) claustrum, (4) predominant subcortical, and (5) splenium involvement. Amongst treatment-responsive SE patients, the cortical pattern was the most prevalent whereas hippocampal involvement was most frequently reported in refractory SE. Cortical atrophy, hippocampal sclerosis, and cortical laminar necrosis were common long-term sequelae after the resolution of SRMA. In this review, we highlight many limitations of the literature and discuss future directions for research.
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Affiliation(s)
- Frederick P Mariajoseph
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Parveen Sagar
- Department of Neurology, Monash Medical Centre, Clayton, Melbourne, Australia
| | | | | | - Udaya Seneviratne
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Monash Medical Centre, Clayton, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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Abstract
INTRODUCTION Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS. AIM We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures. RESULTS We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES. CONCLUSION ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.
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Abstract
The most feared complication after acute ischemic stroke is symptomatic or asymptomatic hemorrhagic conversion. Neuroimaging and clinical criteria are used to predict development of hemorrhage. Seizures after acute ischemic stroke or stroke-like symptoms from seizures are not common but may lead to confusion in the peristroke period, especially if seizures are repetitive or evolve into status epilepticus, which could affect neuroimaging findings. Malignant infarction develops when cytotoxic edema is large enough to lead to herniation and death. Post-stroke neuroimaging prognosticators have been described and should be assessed early so that appropriate treatment is offered before herniation leads to additional tissue injury.
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Williams JA, Bede P, Doherty CP. An exploration of the spectrum of peri-ictal MRI change; a comprehensive literature review. Seizure 2017; 50:19-32. [PMID: 28600921 DOI: 10.1016/j.seizure.2017.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this review was to identify published studies in the literature relating to ictal induced MRI change and to identify certain common themes, practical points for clinicians and areas for future research. METHODS We identified 96 articles that satisfied our inclusion criteria yielding 575 cases. All articles were analysed; number of subjects, spectrum of MRI and EEG change, aetiology, and follow-up (both clinical and imaging) were noted. RESULTS The most frequent imaging changes were restricted diffusion, T2-hyperintensity and reduced ADC values. The mesial temporal structures and neocortex were most commonly affected locations though subcortical structures like the thalamus and pulvinar were also described. Practical clinical points included; the development of PLEDS concordant with ictal imaging change was associated with worse clinical prognosis, patients with seizures due to symptomatic aetiology may be more likely to develop ictal related imaging change and follow up is vitally important to ensure that ictal related oedema is not misidentified as a mass lesion or conversely that a mass lesion is not misidentified as ictal related change. CONCLUSION Qualitative MRI studies have provided clinicians with useful in-vivo insights into the dynamic ictal neuronal environment. Changes are not only localised to the ictal focus but can be remote and irreversible. Small patient numbers varying study design and high numbers of symptomatic seizures makes comparison between studies problematic. Also there is possible microstructural quantitative MRI changes that are missed on qualitative MRI. There is a need for prospective quantitative MRI studies in patients with epilepsy peri-icatlly with a uniform period of follow up and comparison to control data.
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Affiliation(s)
- Jennifer A Williams
- Department of Neurology,St. James's Hospital, James's Street, Dublin 8, Ireland; Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College,152-160 Pearse Street, Dublin 2, Ireland.
| | - Peter Bede
- Department of Neurology,St. James's Hospital, James's Street, Dublin 8, Ireland; Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College,152-160 Pearse Street, Dublin 2, Ireland
| | - Colin P Doherty
- Department of Neurology,St. James's Hospital, James's Street, Dublin 8, Ireland; Academic Unit of Neurology, Trinity Biomedical Science Institute, Trinity College,152-160 Pearse Street, Dublin 2, Ireland
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Elliott CA, Ramaswamy V, Jacob FD, Sankar T, Mehta V. Early diffusion restriction of white matter in infants with small subdural hematomas is associated with delayed atrophy. Childs Nerv Syst 2017; 33:289-295. [PMID: 27766468 DOI: 10.1007/s00381-016-3271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of infant morbidity and mortality. In these patients, magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) is the test of choice to describe the extent of microstructural injury. CASE PRESENTATION AND DISCUSSION In this case series, we describe novel acute and chronic MRI findings in four infants (6-19 months) with small, unilateral subdural hematomas in whom the etiology of head injury was suspicious for non-accidental trauma (NAT). Acute (<1-week post-injury) DWI revealed extensive areas of restricted diffusion isolated to the cerebral white matter predominantly ipsilateral to the subdural hematoma. After prolonged pediatric intensive care treatment including subdural evacuation (n = 2) or decompressive craniectomy (n = 1), all patients survived albeit with significant motor and cognitive deficits. Delayed structural MRI (6-9-year post-injury) demonstrated cortical and subcortical atrophy well-correlated with areas of acute restricted diffusion. CONCLUSION These four cases highlight that relatively small subdural hematomas can be associated with extensive white matter injury-detectable only by early DWI-which have long-term structural and functional consequences.
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Affiliation(s)
- Cameron A Elliott
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois D Jacob
- Division of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
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Lee E, Kim K, Lee E, Lee J. Characteristic MRI findings in hyperglycaemia-induced seizures: diagnostic value of contrast-enhanced fluid-attenuated inversion recovery imaging. Clin Radiol 2016; 71:1240-1247. [DOI: 10.1016/j.crad.2016.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
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Hwang KJ, Park KC, Yoon SS, Ahn TB. Unusual lesion in the bilateral external capsule following status epilepticus: a case report. J Epilepsy Res 2014; 4:88-90. [PMID: 25625096 PMCID: PMC4295061 DOI: 10.14581/jer.14019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/04/2014] [Indexed: 11/03/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an essential tool for determining the underlying cause of status epilepticus and can exhibit a variety of unpredictable findings. A 28-year-old woman presented with status epilepticus of unknown etiology. She had been recovered from status epilepticus twenty days later, but afterwards developed transient postural instability and cognitive impairment. Initial MRI showed no abnormalities. Follow-up MRI after cessation of status epilepticus demonstrated hyper-intensities lesions in the right claustrum and bilateral external capsular areas on T2 fluid attenuated inversion recovery images. As the external capsule is a route for cholinergic and corticostriatal fibers, cognitive dysfunction and postural instability might be related to these fibers.
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Affiliation(s)
- Kyoung Jin Hwang
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Key-Chung Park
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Sang Yoon
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
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Fujita K, Izumi Y, Harada M, Kaji R. Crossed cerebellar hyperperfusion without restricted diffusion in status epilepticus. J Neurol 2012. [DOI: 10.1007/s00415-012-6773-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maalouf N, Keyrouz S. Early Appearance of Diffusion-Weighted Hyperintensities in Aphasic Status Epilepticus. Neuroradiol J 2012; 25:36-9. [DOI: 10.1177/197140091202500105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 11/02/2011] [Indexed: 11/17/2022] Open
Abstract
Partial status epilepticus rarely manifests mainly with global aphasia. It usually results in diffusion-weighted imaging (DWI) abnormalities after prolonged seizures. We discuss the magnetic resonance imaging (MRI) findings in a patient with aphasic status epilepticus. MRI showed diffusion restriction four hours after onset of symptoms. We summarize previously reported brain imaging findings in status epilepticus and discuss the purported mechanism behind these changes. Findings in our patient, similar to few others described in the literature, suggest that cortical DWI hyperintensities can occur shortly following aphasic status epilepticus.
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Affiliation(s)
- N. Maalouf
- University Of Arkansas For Medical Sciences; Little Rock, Arkansas, Usa
| | - S.G. Keyrouz
- University Of Arkansas For Medical Sciences; Little Rock, Arkansas, Usa
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Gujjar A, Jacob PC, Al-Asmi A, Ramachandiran N, Obaidi A, Jain R. Reversible MRI changes in prolonged status epilepticus: a case report. Int J Neurosci 2011; 121:341-5. [PMID: 21348796 DOI: 10.3109/00207454.2011.556281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
MRI is an essential investigation in epilepsy and status epilepticus (SE) for determining the underlying cause. However, SE or prolonged seizures may themselves induce changes in the MRI resulting in difficulty in interpretation. This case report illustrates a patient who recovered completely from prolonged generalized idiopathic SE lasting more than 2 weeks and had transient bilateral external capsule, fronto-temporal, and insular cortical MRI changes. The mechanism of such MRI changes and their implications for survival even after prolonged SE are discussed.
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Affiliation(s)
- Arunodaya Gujjar
- Neurology Unit, Department of Medicine, Sultan Qaboos University, Muscat, Oman
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Canas N, Breia P, Soares P, Saraiva P, Calado S, Jordão C, Vale J. The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities. Epilepsy Res 2010; 91:240-52. [PMID: 20728314 DOI: 10.1016/j.eplepsyres.2010.07.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 07/22/2010] [Accepted: 07/25/2010] [Indexed: 12/20/2022]
Abstract
The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities (TPMA) remains largely unclear. This prompted us to perform a prospective observational cohort study, including electroencephalography (EEG) and multi-sequence MRI, in 19 consecutive patients (8 female, mean age 51.7 years) with TPMA induced by convulsive and non-convulsive status epilepticus (n=14) or isolated seizures. TPMA were associated with focal, lateralized or diffuse EEG abnormalities, and were mostly focal unilateral and cortico-subcortical (n=11), less frequently cortically restricted, bilateral, hemispheric and with remote lesions (pulvinar, cerebellum); 66.7% had cortico-pial contrast enhancement and 93.7% restriction on diffusion-weighted imaging, with cortical cytotoxic edema on apparent-diffusion coefficient, only tumor-like TPMA (n=5) presenting noticeable subcortical vasogenic edema. The heterogeneity of clinical, EEG and MRI findings contributed to a 38.6% strict focal topographic concordance between them, with the more widespread findings also attributable to the time lag between studies, seizure dynamics/etiologies and cerebral reserve. At follow-up (mean duration 29.6 months, 3-120), the brain damage induced by TPMA was responsible for a high incidence of clinical and MRI sequelae (63.2%), only tumor-like/small TPMA induced by acute symptomatic seizures presenting good clinical outcomes. Our findings may contribute to a better definition and comprehension of the TPMA electroclinical-imagiological spectrum, pathophysiology and long-term outcome.
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Affiliation(s)
- Nuno Canas
- Department of Neurology, Hospital de Egas Moniz, Lisbon, Portugal.
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Canas N, Soares P, Calado S, Pestana R, Ribeiro C, Vale J. Pathophysiology and Long-Term Outcome of Reversible Tumor-Like Lesions Induced by Presenting Status Epilepticus. J Neuroimaging 2010; 20:169-74. [DOI: 10.1111/j.1552-6569.2008.00334.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Penumbra, the basis of neuroimaging in acute stroke treatment: current evidence. J Neurol Sci 2009; 288:13-24. [PMID: 19875134 DOI: 10.1016/j.jns.2009.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 08/06/2009] [Accepted: 09/23/2009] [Indexed: 11/23/2022]
Abstract
In modern medicine brain imaging is an essential prerequisite not only to acute stroke triage but also to determining the specific therapy indicated. This article reviews the need for imaging the brain in acute stroke, penumbral pathophysiology, penumbral imaging techniques, as well as current status of various imaging modalities that are being employed to select patients for specific therapeutic approaches.
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Role of cranial imaging in epileptic status. Eur J Radiol 2009; 70:475-80. [DOI: 10.1016/j.ejrad.2008.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 01/02/2008] [Accepted: 02/11/2008] [Indexed: 11/22/2022]
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Goyal MK, Sinha S, Ravishankar S, Shivshankar JJ. Peri-ictal signal changes in seven patients with status epilepticus: interesting MRI observations. Neuroradiology 2008; 51:151-61. [DOI: 10.1007/s00234-008-0479-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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Sheerin F, Pretorius P, Briley D, Meagher T. Differential diagnosis of restricted diffusion confined to the cerebral cortex. Clin Radiol 2008; 63:1245-53. [DOI: 10.1016/j.crad.2007.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 12/09/2007] [Accepted: 12/20/2007] [Indexed: 02/03/2023]
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Yu JT, Tan L. Diffusion-weighted magnetic resonance imaging demonstrates parenchymal pathophysiological changes in epilepsy. ACTA ACUST UNITED AC 2008; 59:34-41. [PMID: 18514917 DOI: 10.1016/j.brainresrev.2008.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 04/24/2008] [Accepted: 04/25/2008] [Indexed: 10/22/2022]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is a novel noninvasive technique probing the Brownian motion of water molecules. It has already proved very useful in the early identification of cerebral ischemia in human patients. Although a wide spectrum of peri-ictal, postictal or interictal DW-MRI abnormalities are recently being increasingly identified, clinicians are often in a dilemma about their significance in epilepsy. This article briefly reviews the whole dynamic ADC fluctuations and the implications of hypothetical pathophysiological evolution of effected zones in prolonged seizures or status epilepticus (SE) and their potential clinical applications in epilepsy.
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Affiliation(s)
- Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, Affiliated Hospital of Qingdao University Medical College, Shandong Province, PR China
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Desguerre I, Marti I, Valayannopoulos V, Bahi-Buisson N, Dulac O, Plouin P, Delonlay P, Hertz-Pannier L, Boddaert N. Transient magnetic resonance diffusion abnormalities in West syndrome: the radiological expression of non-convulsive status epilepticus? Dev Med Child Neurol 2008; 50:112-6. [PMID: 18201300 DOI: 10.1111/j.1469-8749.2007.02017.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to report patients with pharmacoresistant West syndrome of unknown cause whose magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) showed a transient decrease of diffusion in subcortical structures. Of 20 patients investigated over a 2-year period, three males and three females constitute the present series. They had daily clusters of infantile spasms with hypsarrhythmia for 4 to 24 months before the first investigation. Four were severely hypotonic. All aetiological studies involving intermediary metabolism, peroxysomes, mitochondria, and neurotransmitters in cerebrospinal fluid were negative. Patients underwent DWI when first examined at the mean age of 13 months, and on follow-up examination 6 to 18 months later. Diffusion was decreased in the pallidi and posterior brainstem. It was also decreased for five patients in thalami and for three in dentate nuclei. Repeat MRI, performed when spasms were still present but hypsarrhythmia had ceased, did not show the same abnormalities. Because of recruitment bias, this series probably overestimates the true incidence of such DWI abnormalities. The eventuality of toxic lesions, including some inborn error of metabolism or drug toxicity, is considered unlikely although it could not be excluded. The contribution of the epileptic encephalopathy itself appears the most likely course.
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Affiliation(s)
- Isabelle Desguerre
- Department of Neuropaediatrics, APHP, Necker-Enfants Malades Hospital, Paris, France.
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Raghavendra S, Ashalatha R, Thomas SV, Kesavadas C. Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state. Neuroradiology 2007; 49:299-305. [PMID: 17200865 DOI: 10.1007/s00234-006-0189-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 11/10/2006] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Neuroimaging in seizures associated with nonketotic hyperglycemia (NKH) is considered normal. We report magnetic resonance imaging (MRI) abnormalities in four patients with NKH and seizures. METHODS We prospectively evaluated clinical and radiological abnormalities in four patients with NKH during the period March 2004 to December 2005. RESULTS All patients presented with seizures, either simple or complex partial seizures or epilepsia partialis continua. Two of them had transient hemianopia. MRI showed subcortical T2 hypointensity in the occipital white matter and in or around the central sulcus (two patients each), T2 hyperintensity of the overlying cortex (two patients), focal overlying cortical enhancement (three patients) and bilateral striatal hyperintensity (one patient). Diffusion-weighted imaging (DWI) performed in three patients showed restricted diffusion. The ictal semiology and electroencephalographic (EEG) findings correlated with the MRI abnormalities. On clinical recovery, the subcortical T2 hypointensity and striatal hyperintensity reversed in all patients. The initial cortical change evolved to FLAIR hyperintensity suggestive of focal cortical gliosis. The radiological differential diagnosis considered initially included encephalitis, malignancy and hemorrhagic infarct rendering a diagnostic dilemma. CONCLUSION We identified subcortical T2 hypointensity rather than hyperintensity as a characteristic feature of seizures associated with NKH. Only very few similar reports exist in literature. Reversible bilateral striatal T2 hyperintensity in NKH has not been reported to the best of our knowledge.
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Affiliation(s)
- S Raghavendra
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011 Kerala, India
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Raghavendra S, Ashalatha R, Krishnamoorthy T, Kesavadas C, Thomas SV, Radhakrishnan K. Reversible periictal MRI abnormalities: Clinical correlates and long-term outcome in 12 patients. Epilepsy Res 2007; 73:129-36. [PMID: 17125968 DOI: 10.1016/j.eplepsyres.2006.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 08/30/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
Although a wide spectrum of reversible periictal magnetic resonance imaging (MRI) abnormalities (RPMA) are being increasingly identified, the clinicians are often in a dilemma about their localization significance. This prompted us to analyze the clinical, MRI, electroencephalographic (EEG) and follow-up data of 12 patients with RPMA seen in a tertiary referral epilepsy center. RPMA occurred after a single or a cluster of focal seizures with or without secondary generalization. The interictal and ictal EEG abnormalities were localized to the site of RPMA in nine patients. RPMA involved areas remote from the site of EEG abnormalities in four patients. We have developed a comprehensive classification to account for the wide spectrum of RPMA involving gray matter, white matter and leptomeninges with or without contrast enhancement or mass effect. Follow-up MRIs showed complete resolution of RPMA in all, except in four patients, who developed residual focal atrophy. During median follow-up period of 3 years, recurrence of RPMA was observed in two patients. Diffusion weighted MRI in two patients and histopathological finding in one patient favored causal role of hypoxia in the pathogenesis of RPMA. Our observations help to understand the electroclinical profile, radiological spectrum, localization significance and natural history of RPMA better.
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Affiliation(s)
- S Raghavendra
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
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Tucker A, Miyake H, Tsuji M, Ukita T, Nishihara K. Transient Occipitotemporal Subcortical Diffusion-Weighted Magnetic Resonance Imaging Abnormalities Associated With Status Epilepticus-Case Report-. Neurol Med Chir (Tokyo) 2006; 46:240-3. [PMID: 16723816 DOI: 10.2176/nmc.46.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 30-year-old man presented with a generalized seizure manifesting as decreased consciousness. Diffusion-weighted magnetic resonance imaging showed transient areas of high intensity in the gray and subcortical white matter of the left occipital and temporal lobes. The lesions did not reflect the vascular territories. After a period of over 2 weeks, his consciousness level improved associated with reduced intensity of the abnormal areas. These findings suggest that seizure induced reversible cytotoxic and vasogenic edema. Transient diffusion-weighted magnetic resonance imaging abnormalities may be associated with generalized seizures and the intensity may reflect the clinical condition.
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Affiliation(s)
- Adam Tucker
- Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan.
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Lövblad KO, Baird AE. Actual diagnostic approach to the acute stroke patient. Eur Radiol 2005; 16:1253-69. [PMID: 16372164 DOI: 10.1007/s00330-005-0103-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 11/18/2005] [Accepted: 11/25/2005] [Indexed: 10/25/2022]
Abstract
Since acute stroke is now considered a potentially treatable medical emergency, a rapid and correct diagnosis must be made. The first step is to exclude hemorrhage, then to visualize any early ischemic changes, demonstrate the presence of hypoperfusion and locate the presence of a vascular underlying pathology as well as elucidate the presence of a potential penumbra (tissue at risk). Thanks to improvements and advances in both MR and CT technology, this can now be done in a number of ways. At the moment, CT is the most widely available and fast method for obtaining imaging of the brain and neck vessels of patients presenting with acute stroke. MRI can provide more precise information, although it remains slightly more time-consuming, but is, however, the method of choice for follow-up imaging. The main point is to take the one-stop-shopping approach where imaging of the vessels and brain is done from the aortic arch to the circle of Willis in one single session in order to have all the necessary information in the acute phase.
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Affiliation(s)
- Karl-Olof Lövblad
- Neuroradiology Unit, Radiology Department, SRRI, HUG Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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Mraovitch S, Calando Y, Régnier A, Lamproglou I, Vicaut E. Post-seizures amygdaloallocortical microvascular lesion leading to atrophy and memory impairment. Neurobiol Dis 2005; 19:479-89. [PMID: 16023590 DOI: 10.1016/j.nbd.2005.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 01/25/2005] [Accepted: 01/28/2005] [Indexed: 12/01/2022] Open
Abstract
Although the incidence of seizures after a cerebrovascular event including intracerebral hemorrhage has been widely recognized, the present studies have demonstrated that generalized convulsive seizures can cause multifocal amygdaloallocortical hemorrhage and tissue necrosis, the origin of which remains to be established. The seizure-elicited amygdaloallocortical injured area, which we refer to as a focal injury-prone area (FIPA), was caused by cholinergic stimulation of the ventroposterolateral and thalamic reticular nuclei. The amygdaloallocortical injury was preceded by focal absence of neuronal COX-2 and presence of microvascular immunoreactivity to the pro-inflammatory cytokines, IL-1beta and TNF-alpha. The microvascular inflammation was followed by edema and multifocal amygdaloallocortical microhemorrhages, leading to atrophy and cognitive impairment. On the basis of the present results, we conclude that generalized convulsive seizures may be at the origin of amygdaloallocortical microvascular injury suggesting that, in addition to anticonvulsant treatment, an appropriate clinical evaluation and therapy for seizures-associated cerebrovascular accidents should be considered.
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Affiliation(s)
- Sima Mraovitch
- Laboratoire de Recherche Cérébrovasculaires CNRS URA 641, Université Paris VII, 10, av de Verdun, 75010 Paris, France.
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Abstract
Pediatric neuroradiology is a fascinating and challenging field because there are normal changes associated with normal development and unique and unusual pathologies that occur in this population. The numerous new MR techniques first applied in the adult population are appropriate for use in the pediatric population, often with minimal modification of parameters. These new techniques will undoubtedly contribute significantly to use of pediatric neuroimaging, but the adult experience is not always directly transferable. The pediatric brain, particularly the immature brain is different in structure, has predilection for different types of disease processes, and may react differently to insults than the adult brain. As a result, the role of these techniques needs to be evaluated in the context of the pediatric brain and common pediatric disease processes.
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Affiliation(s)
- P Ellen Grant
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray Building B285, Boston, MA 02114, USA.
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