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MRI abnormalities associated with partial status epilepticus
M G Lansberg1, M W O'Brien, A M Norbash
1Stanford Stroke Center, UCSF Stanford Health Care, Palo Alto, CA 94304-1705, USA.
Objective:
To report neuroimaging findings in patients with complex partial status epilepticus.
Background:
During status epilepticus, neuroimaging may be used to exclude other neurologic conditions. Therefore, it is important to identify the neuroimaging features that are associated with status epilepticus. In addition, MRI characteristics may provide insight into the pathophysiologic changes during status epilepticus.
Methods:
The history and neuroimaging examination results of three patients with complex partial status epilepticus were reviewed. Studies obtained during status epilepticus included diffusion-weighted MRI (DWI), MR angiography (MRA), postcontrast T1-weighted MRI, T2-weighted MRI, and CT. Follow-up MRI was obtained in two patients, and autopsy results were available for the third.
Results:
Some of the MRI and CT findings during partial status epilepticus mimicked those of acute ischemic stroke: DWI and T2-weighted MRI showed cortical hyperintensity with a corresponding low apparent diffusion coefficient, and CT showed an area of decreased attenuation with effacement of sulci and loss of gray-white differentiation. However, the lesions did not respect vascular territories, there was increased signal of the ipsilateral middle cerebral artery on MRA, and leptomeningeal enhancement appeared on postcontrast MRI. On follow-up imaging, the abnormalities had resolved, but some cerebral atrophy was present.
Conclusions:
The radiologic characteristics of status epilepticus resemble those of ischemic stroke but can be differentiated based on lesion location and findings on MRA and postcontrast MRI. The MRI abnormalities indicated the presence of cytotoxic and vasogenic edema, hyperperfusion of the epileptic region, and alteration of the leptomeningeal blood-brain barrier. These changes reversed, but they resulted in some regional brain atrophy.
Insights
Neuroimaging in complex partial status epilepticus can mimic stroke but is distinguishable. Key MRI and CT findings help differentiate, though some brain atrophy may persist.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Neuroimaging is crucial for excluding other conditions during status epilepticus.
- Identifying specific neuroimaging features aids diagnosis and understanding pathophysiology.
- MRI characteristics offer insights into dynamic changes during seizures.
Observation:
- Three patients with complex partial status epilepticus underwent comprehensive neuroimaging, including diffusion-weighted MRI (DWI), MR angiography (MRA), and postcontrast T1-weighted MRI.
- CT and MRI findings initially resembled acute ischemic stroke, showing cortical hyperintensity and decreased attenuation.
- Follow-up imaging revealed resolution of abnormalities with some resultant cerebral atrophy.
Findings:
- Cortical hyperintensity on DWI and T2-weighted MRI with low apparent diffusion coefficient.
- Lesions did not conform to vascular territories, distinguishing them from ischemic stroke.
- MR angiography showed ipsilateral middle cerebral artery signal increase, and postcontrast MRI revealed leptomeningeal enhancement.
Implications:
- Radiologic features of status epilepticus can be differentiated from ischemic stroke using MRA and postcontrast MRI.
- MRI abnormalities signify cytotoxic/vasogenic edema, hyperperfusion, and blood-brain barrier disruption.
- While reversible, these changes can lead to regional brain atrophy, highlighting the impact of prolonged seizures.