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The reversible focal MRI abnormalities in complex partial seizure: technical instruction
Kook-Hee Yang1, Dong-Seok Kim, Joong-Uhn Choi
1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, C PO Box 8044, Seoul, Korea.
Case Report:
A 17-month-old infant girl was admitted with complex partial seizures and right side hemiparesis. Five days after the last seizure, MR signal changes were observed in the left hemisphere with a cavernous hemangioma in the middle temporal gyrus. However, these MR signal changes had normalized 11 days after the last seizure, except for the cavernous hemangioma. The scalp EEG findings revealed that the epileptic focus was on the mid-temporal gyrus. The patient underwent lesionectomy only. Two months after this operation the MR showed no signal abnormality. Throughout a 12-month follow-up after surgery the patient remained seizure free.
Discussion:
MR signal changes in seizure patients do not always indicate the structural region concerned, but can be transient signal changes. They may be due to the propagation of epileptic discharge along the association fiber from the seizure focus. However, transient signal changes after seizure must be followed up to allow exclusion of a tumor and other diseases.
Insights
Transient MR signal changes in infants with seizures may not indicate structural abnormalities but can result from epileptic discharge propagation. Follow-up is crucial to rule out tumors and other conditions.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Epilepsy in infants can present with complex partial seizures and hemiparesis.
- Magnetic Resonance (MR) imaging is a key tool for diagnosing neurological conditions.
- Understanding the nature of MR signal changes post-seizure is critical for accurate diagnosis.
Observation:
- A 17-month-old infant experienced complex partial seizures and right hemiparesis.
- MR imaging revealed transient signal changes in the left hemisphere, alongside a cavernous hemangioma.
- Scalp electroencephalogram (EEG) localized the epileptic focus to the mid-temporal gyrus.
Findings:
- The observed MR signal changes normalized within 11 days post-seizure, excluding the hemangioma.
- Following a lesionectomy of the cavernous hemangioma, MR showed no abnormalities.
- The patient remained seizure-free during a 12-month post-operative follow-up.
Implications:
- Transient MR signal alterations in epilepsy patients may not always correlate with structural lesions.
- These changes can be indicative of epileptic discharge propagation along neural pathways.
- Post-seizure MR findings necessitate careful follow-up to differentiate from structural pathologies like tumors.
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