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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.
Neurology
|April 2, 1999
Summary
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.