MRI findings in aphasic status epilepticus

Area of Science:

• Neurology
• Neuroradiology
• Neuroimaging

Background:

• Ictal-MRI studies, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and MR-angiography (MRA), are scarce in patients experiencing aphasic status epilepticus (ASE).
• This study aims to elucidate the effects of ASE on DWI findings and its impact on cerebral blood flow.

Observation:

• Eight patients with ASE, confirmed by ictal-EEG, underwent ictal-MRI shortly after symptom onset (mean delay: 3 hours).
• ASE presented as fluctuating aphasia, often accompanied by subtle contralateral neurological deficits like hemiparesis or hemianopia.

Findings:

• MRI revealed temporoparietal cortical hyperintensity on DWI in six patients, with four also exhibiting ipsilateral pulvinar lesions.
• Five patients demonstrated localized hyperperfusion corresponding to DWI lesions, alongside increased middle cerebral artery blood flow.
• Lesion resolution on follow-up MRI correlated with the interval between imaging sessions.

Implications:

• ASE can manifest with DWI lesions in the temporoparietal cortex and pulvinar nucleus, coupled with local hyperperfusion.
• These imaging abnormalities may occur even when distant from the epileptic focus or primary language areas.
• Findings underscore the utility of advanced MRI techniques in diagnosing and understanding the pathophysiology of ASE.