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Changes on diffusion-weighted MRI with focal motor status epilepticus: case report
P Senn1, K O Lövblad, D Zutter
1Department of Neurology, Inselspital, University Hospital, Berne, Switzerland.
Neuroradiology
|April 11, 2003
Summary
Diffusion-weighted imaging (DWI) reveals transient abnormalities in focal status epilepticus. In a patient with focal motor seizures, higher apparent diffusion coefficients (ADC) indicated edema, followed by atrophy, suggesting cytotoxic and vasogenic edema.
Area of Science:
- Neurology
- Neuroradiology
- Neuroimaging
Background:
- Focal status epilepticus can present with transient neuroimaging abnormalities.
- Diffusion-weighted imaging (DWI) offers insights into the underlying pathophysiology of these changes.
Observation:
- A 53-year-old male experienced focal motor status epilepticus affecting the left hand, arm, and face, with concurrent focal slowing on electroencephalogram (EEG).
- Initial magnetic resonance imaging (MRI) revealed higher apparent diffusion coefficients (ADC) in the affected left hemisphere compared to the unaffected side.
Findings:
- Follow-up MRI scans at 10 days and 6 weeks post-seizure cessation demonstrated normalization of ADC values.
- Persistent findings included progressive atrophy of the previously affected left cerebral hemisphere.
Implications:
- The observed MRI changes suggest a combination of cytotoxic and vasogenic edema during the acute seizure phase.
- Subsequent parenchymal loss (atrophy) indicates the potential for permanent brain damage following prolonged focal epileptic activity.