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Seizures: Classification01:13

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Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
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Decreased Subcortical T2 FLAIR Signal Associated with Seizures.

P Nicholson1, S Abdulla2, L Alshafai2

  • 1From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. patrick.nicholson@uhn.ca.

AJNR. American Journal of Neuroradiology
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Decreased T2/T2 FLAIR signal on brain MRI, often seen with seizures, indicates intracranial pathologies. These MRI findings correlate with abnormal electroencephalogram activity, aiding in diagnosis.

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Area of Science:

  • Neuroradiology
  • Neuroimaging
  • Clinical Neurology

Background:

  • Abnormal T2/T2 FLAIR signal on brain MRI is associated with seizures and intracranial pathologies.
  • This imaging finding can be subtle and requires careful evaluation.

Purpose of the Study:

  • To characterize the neuroimaging findings of decreased T2/T2 FLAIR signal in patients with seizures.
  • To correlate these imaging findings with clinical presentation and electroencephalogram (EEG) results.

Main Methods:

  • Retrospective review of 29 patients with decreased T2/T2 FLAIR signal on brain MRI.
  • Analysis of MRI sequences including DWI, ADC, SWI/GRE, and contrast-enhanced scans.
  • Correlation with clinical seizure history and EEG findings within 24 hours of imaging.

Main Results:

  • Decreased T2/T2 FLAIR signal was unilateral in 75.9% of patients, affecting anterior circulation lobes.
  • Associated findings included decreased DWI signal (96.6%) and low SWI/GRE signal (89.7%), with normal ADC values.
  • The most frequent concomitant pathology was subdural hematoma; no abnormal enhancement was noted on contrast scans.
  • 75.9% of patients had documented clinical seizures on the day of imaging.
  • All available EEGs (65.5%) showed abnormal activity, localized or bilateral, corresponding to MRI findings.

Conclusions:

  • Decreased white matter T2/T2 FLAIR signal changes on brain MRI are associated with seizures.
  • These imaging findings often correlate with abnormal, localized or bilateral EEG activity.
  • This pattern suggests a potential imaging biomarker for specific neurological conditions.