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Published on: September 25, 2019
Reversible postictal MRI change mimicking structural lesion
Tufan Hicdonmez1, Ufuk Utku, Nilda Turgut
1Department of Neurosurgery, Trakya University Medical Faculty, 22030, Edirne, Turkey. nildaturgut@hotmail.com
Abstract:
A reversible change on magnetic resonance imaging (MRI) following generalised seizure mimicking a tumour-like structural lesion is reported in a 15-year-old patient. MRI revealed a left fronto-parietal cortico-subcortical lesion on T2 weighted images. The control MRI after 5 weeks from the onset revealed no pathological finding. The reversible MRI changes may be the result of a local brain swelling, and a defect of cerebral autoregulation during seizure at the site of activity. The transient nature of such neuroradiological findings have to be taken into consideration in the differential diagnosis because of their similar appearance on imaging to intrinsic brain tumours.
Insights
Transient MRI changes after generalized seizures can mimic brain tumors in adolescents. Follow-up imaging confirmed these lesions were reversible, highlighting the importance of considering seizure-induced swelling in differential diagnoses.
Area of Science:
- Neurology
- Neuroradiology
- Neuroimaging
Background:
- Generalized seizures can present with complex neurological symptoms.
- Magnetic resonance imaging (MRI) is crucial for diagnosing structural brain abnormalities.
- Distinguishing seizure-related changes from intrinsic brain tumors is clinically significant.
Observation:
- A 15-year-old patient experienced a generalized seizure.
- Initial MRI revealed a left fronto-parietal cortico-subcortical lesion on T2-weighted images, mimicking a tumor.
- A follow-up MRI after 5 weeks showed complete resolution of the lesion.
Findings:
- The observed MRI changes were reversible and transient.
- These reversible findings are attributed to localized cerebral edema and impaired autoregulation during the seizure.
- The lesion's appearance on MRI was similar to that of intrinsic brain tumors.
Implications:
- Transient, seizure-induced MRI abnormalities should be considered in the differential diagnosis of focal brain lesions.
- Awareness of these reversible findings can prevent misdiagnosis and unnecessary invasive procedures.
- This case underscores the dynamic nature of brain imaging findings in the context of epileptic seizures.
