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Matsumoto N, Ogawa T, Shibazaki K, Hishikawa N, Wakutani Y, Takao Y. Usefulness of magnetic resonance imaging in differentiation between status epilepticus and acute ischemic stroke. J Neurol Sci 2024; 462:123066. [PMID: 38824818 DOI: 10.1016/j.jns.2024.123066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/10/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Status epilepticus, characterized by the temporal neurological deficits, often mimics acute ischemic stroke. We investigated the usefulness of magnetic resonance imaging for differentiation of status epilepticus from acute ischemic stroke. METHODS A retrospective case series of patients with status epilepticus who underwent brain magnetic resonance imaging. For comparative analysis, a series of patients with acute ischemic stroke caused by unilateral middle cerebral artery occlusion was used. RESULTS Ten patients (4 females and 6 males) with status epilepticus who underwent brain magnetic resonance imaging were included. The median age at diagnosis was 82 years (age range, 70-90 years). In all ten patients, hyperintensities in diffusion-weighted imaging with decreased apparent diffusion coefficient values, decreased venous intensity in susceptibility-weighted imaging, and hyperperfusion in arterial spin labeling perfusion were detected in the cortex of the affected side. Four patients showed an additional diffusion restriction in the thalamus. The apparent diffusion coefficient value of the lesional area was 13.1% less than the contralateral, which was less than one-third as acute ischemic stroke. Status epilepticus patients showed no change in medullary venous intensity of the affected area in susceptibility-weighted imaging, whereas acute ischemic stroke patients showed increased cortical and medullary venous intensity in affected hemisphere. Seven of eight patients with status epilepticus who underwent magnetic resonance angiography showed dilation of the cerebral arteries in the ipsilateral side. CONCLUSIONS The combined use of diffusion-weighted imaging, susceptibility-weighted imaging, and arterial spin labeling perfusion may help accurate and prompt diagnosis of status epilepticus.
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Affiliation(s)
- Namiko Matsumoto
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Toshihide Ogawa
- Neuroradiology Center, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Kensaku Shibazaki
- Department of Stroke Medicine, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Nozomi Hishikawa
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan
| | - Yosuke Wakutani
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
| | - Yoshiki Takao
- Department of Neurology, Kurashiki Heisei Hospital, 4-3-38, Oimatsu-cho, Kurashiki, Okayama 710-0826, Japan.
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Damavandi PT, Calì D, Negro G, Girombelli A, Lattanzi S. Contrast Medium-Induced Transient Cortical Blindness: A Systematic Review of the Literature. J Vasc Interv Radiol 2024:S1051-0443(24)00400-7. [PMID: 38906244 DOI: 10.1016/j.jvir.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/25/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To summarize identified risk factors, the most common clinical presentations, radiological and neurophysiological features, and proposed pathophysiological mechanisms of contrast medium-induced transient cortical blindness (TCB). METHODS A systematic search of PubMed, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov was performed. A total of 115 patients from 2 retrospective cohort studies, 10 case series, and 52 case reports were included. RESULTS The available evidence suggests that TCB can manifest after both invasive and noninvasive contrast-enhanced procedures. The pathophysiology of TCB is unclear; however, the primary mechanism suggested involves the direct neurotoxic effect of the contrast medium. Ionic, nonionic, hyperosmolar, isoosmolar, and even ethiodized oil have been implicated. Imaging findings are nonspecific, and absent in about half of patients. Onset is within 30 minutes in about half of patients and resolves within 1 day in about half of patients, but delayed onset after a day and delayed resolution after a week may occur. Higher contrast medium dosage and its injection solely into the posterior circulation were the only risk factors identified in association with TCB. CONCLUSIONS TCB is a rare, idiopathic, and typically self-limited condition associated with direct posterior cerebral neurotoxicity of iodinated contrast media, and appears to be dose-dependent.
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Affiliation(s)
| | - Davide Calì
- Independent Researcher, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Negro
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Girombelli
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
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Bosque Varela P, Tabaee Damavandi P, Machegger L, Prüwasser T, Zimmermann G, Oellerer A, Steinbacher J, McCoy M, Pfaff J, Trinka E, Kuchukhidze G. Magnetic resonance imaging fingerprints of status epilepticus: A case-control study. Epilepsia 2024; 65:1620-1630. [PMID: 38507291 DOI: 10.1111/epi.17949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Status epilepticus (SE) is frequently associated with peri-ictal magnetic resonance imaging (MRI) abnormalities (PMA). However, the anatomical distribution of these alterations has not been systematically studied. The aim of this study was to assess the localization patterns of PMA in patients with SE. METHODS In this prospective case-control study, we compared the distribution and combinations of diffusion-restricted PMA to diffusion-restricted lesions caused by other neurological conditions. All patients of the SE group and the control group underwent MRI including a diffusion-weighted imaging sequence. Patients with SE were imaged within 48 h after its onset. RESULTS We enrolled 201 patients (51 with SE and 150 controls). The most frequent locations of PMA in SE were cortex (25/51, 49%), followed by hippocampus (20/51, 39%) and pulvinar of thalamus (10/51, 20%). In the control group, the cortex was involved in 80 of 150 (53%), white matter in 53 of 150 (35%), and basal ganglia in 33 of 150 (22%). In the control group, the pulvinar of thalamus was never affected and hippocampal structures were rarely involved (7/150, 5%). Involvement of the pulvinar of thalamus and the hippocampus had high specificity for SE at 100% (95% confidence interval [CI] = 98-100) and 95% (95% CI = 91-98), respectively. The sensitivity, however, was low for both locations (pulvinar of thalamus: 20%, 95% CI = 10-33; hippocampus: 39%, 95% CI = 26-54). SIGNIFICANCE Diffusion-restricted MRI lesions observed in the pulvinar of thalamus and hippocampus are strongly associated with SE. These changes may help physicians in diagnosing SE-related changes on MRI in an acute setting, especially in cases of equivocal clinical and electroencephalographic manifestations of SE.
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Affiliation(s)
- Pilar Bosque Varela
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Payam Tabaee Damavandi
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Lukas Machegger
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tanja Prüwasser
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Oellerer
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jürgen Steinbacher
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Mark McCoy
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
| | - Johannes Pfaff
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
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Pina-Garza JE, Chez M, Cloyd J, Hirsch LJ, Kälviäinen R, Klein P, Lagae L, Sankar R, Specchio N, Strzelczyk A, Toledo M, Trinka E. Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher-level emergency: Consensus recommendations of an expert working group. Epileptic Disord 2024. [PMID: 38813941 DOI: 10.1002/epd2.20243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE The management of prolonged seizures (PS) and seizure clusters (SC) is impeded by the lack of international, evidence-based guidance. We aimed to develop expert recommendations regarding consensus definitions of PS, SC, and treatment goals to prevent progression to higher-level emergencies such as status epilepticus (SE). METHODS An expert working group, comprising 12 epileptologists, neurologists, and pharmacologists from Europe and North America, used a modified Delphi consensus methodology to develop and anonymously vote on statements. Consensus was defined as ≥75% voting "Agree"/"Strongly agree." RESULTS All group members strongly agreed that termination of an ongoing seizure in as short a time as possible is the primary goal of rapid and early seizure termination (REST) and that an ideal medication for REST would start to act within 2 min of administration to terminate ongoing seizure activity. Consensus was reached on the terminology defining PS (with proposed thresholds of 5 min for prolonged focal seizures and 2 min for prolonged absence seizures and the convulsive phase of bilateral tonic-clonic seizures) and SC (an abnormal increase in seizure frequency compared with the individual patient's usual seizure pattern). All group members strongly agreed or agreed that patients who have experienced a PS should be offered a REST medication, and all patients who have experienced a SC should be offered an acute cluster treatment (ACT). Further, when prescribing a REST medication or ACT, a seizure action plan should be agreed upon in consultation with the patient and caregiver. SIGNIFICANCE The expert working group had a high level of agreement on the recommendations for defining and managing PS and SC. These recommendations will complement the existing guidance for the management of acute seizures, with the possibility of treating them earlier to potentially avoid progression to more severe seizures, including SE.
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Affiliation(s)
| | - Michael Chez
- Sutter Neuroscience Institute, Sacramento, California, USA
| | - James Cloyd
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Reetta Kälviäinen
- University of Eastern Finland and Epilepsy Center Kuopio University Hospital, Member of the European Reference Network EpiCARE, Kuopio, Finland
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA
| | - Lieven Lagae
- Department Development and Regeneration, Section Paediatric Neurology, Full Member of the European Reference Network EpiCARE, University Hospitals Leuven, Leuven, Belgium
| | - Raman Sankar
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders Unit, Full Member of the European Reference Network EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt, Germany
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d' Hebron University Hospital, Barcelona, Spain
| | - Eugen Trinka
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University, Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Lattanzi S, Orlandi N, Giovannini G, Brigo F, Trinka E, Meletti S. The risk of unprovoked seizure occurrence after status epilepticus in adults. Epilepsia 2024; 65:1006-1016. [PMID: 38339985 DOI: 10.1111/epi.17912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Status epilepticus (SE) may lead to long-term consequences. This study evaluated the risk and predictors of seizure occurrence after SE, with a focus on SE due to acute symptomatic etiologies. METHODS Prospectively collected data about adults surviving a first non-hypoxic SE were reviewed. The outcome was the occurrence of unprovoked seizures during the follow-up. Kaplan-Meier survival curve analysis and log-rank test were used to analyze the time to seizure occurrence and determine the statistical significance between etiological groups. Three subcategories within acute etiology were considered according to the presence of the following: (1) structural lesion (acute-primary); (2) brain involvement during systemic disorders (acute-secondary); and (3) drug or alcohol intoxication/withdrawal (acute-toxic). Cox proportional hazards model was adopted to estimate hazard ratios (HRs) with the 95% confidence intervals (CIs). RESULTS Two hundreds fifty-seven individuals were included. Fifty-four subjects (21.0%) developed seizures after a median of 9.9 (interquartile range 4.3-21.7) months after SE. The estimated 1-, 2-, and 5-year rates of seizure occurrence according to acute SE etiologies were 19.4%, 23.4%, and 30.1%, respectively, for acute-primary central nervous system (CNS) pathology; 2.2%, 2.2%, and 8.7%, respectively, for acute-secondary CNS pathology; and 0%, 9.1%, and 9.1%, respectively, for acute-toxic causes. Five-year rates of seizure occurrence for non-acute SE causes were 33.9% for remote, 65.7% for progressive, and 25.9% for unknown etiologies. In multivariate Cox regression model, progressive etiology (adjusted HR [adjHR] 2.27, 95% CI 1.12-4.58), SE with prominent motor phenomena evolving in non-convulsive SE (adjHR 3.17, 95% CI 1.38-7.25), and non-convulsive SE (adjHR 2.38, 95% CI 1.16-4.90) were independently associated with higher hazards of unprovoked seizures. Older people (adjHR .98, 95% CI .96-.99) and people with SE due to acute-secondary CNS pathology (adjHR .18, 95% CI .04-.82) were at decreased risk of seizure occurrence. SIGNIFICANCE SE carries a risk of subsequent seizures. Both the underlying cause and epileptogenic effects of SE are likely to contribute.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Niccolò Orlandi
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care, and Neurorehabilitation, Christian Doppler University Hospital, Paracelsus Medical University, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
- Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall i.T, Austria
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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Bonduelle T, Ollivier M, Gradel A, Aupy J. Brain MRI in status epilepticus: Relevance of findings. Rev Neurol (Paris) 2024:S0035-3787(24)00423-5. [PMID: 38472033 DOI: 10.1016/j.neurol.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 03/14/2024]
Abstract
Status epilepticus (SE) represents one of the most common neurological emergencies, associated with high mortality and an important risk of functional sequelae in survivors. Magnetic resonance imaging (MRI) offers the possibility of early and noninvasive observation of seizure-induced parenchymal disturbances secondary to the epileptic process. In the present review, we propose a descriptive and comprehensive understanding of current knowledge concerning seizure-induced MRI abnormalities in SE, also called peri-ictal MRI abnormalities (PMAs). We then discuss how PMAs, as a noninvasive biomarker, could be helpful to optimize patient prognostication in SE management. Finally, we discuss alternative promising MRI approaches, including arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), dynamic contrast-enhanced (DCE) MRI and dynamic susceptibility contrast (DSC) MRI that could refine our understanding of SE, particularly in non-convulsive form.
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Affiliation(s)
- T Bonduelle
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - M Ollivier
- Department of Neuroimaging, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - A Gradel
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; CNRS, IMN, UMR 5293, Université de Bordeaux, Bordeaux, France
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