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A pediatric case of transient periictal MRI abnormalities after repeated seizures
Yumeng Zhang1, Fumio Ichinose2, Toshiyuki Maeda1
1Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Department of Pediatrics, Saga-Ken Medical Center Koseikan, Saga, Japan.
Background:
Transient periictal MRI abnormalities (TPMA) are caused by seizures, and may completely or partially reverse within a few days following seizure. Although TPMA are usually observed in patients with status epilepticus (SE), they have also been rarely reported after isolated/recurrent seizures not fulfilling the criteria for SE. Herein, we present a case of a 1-year-old girl with TPMA.
Case:
A 1-year-old girl with Apert syndrome and epilepsy showed MRI abnormalities in the cortico-subcortical areas of the left temporal, occipital and parietal lobes, as well as the left thalamus. These abnormalities showed as a hyperintense signal on diffusion-weighted imaging and a hypointense signal on apparent-diffusion coefficient maps. On follow-up MRI after 3 days, the abnormal signals were completely reversed. We confirmed TPMA after eliminating other possibilities. When treatment was withdrawn, the patient regained consciousness immediately and did not show any abnormality on subsequent MRI.
Conclusion:
TPMA may occur in young children; recognizing this possibility is important for making the diagnosis and conducting appropriate treatment. As a previous study revealed, the distribution of signal changes in cortico-subcortical areas and the ipsilateral thalamus may be a characteristic feature of TPMA.
Insights
Transient periictal MRI abnormalities (TPMA) can occur in young children after seizures. These reversible MRI findings highlight the importance of recognizing TPMA in pediatric epilepsy diagnosis.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neuroimaging
Background:
- Transient periictal MRI abnormalities (TPMA) are typically associated with status epilepticus but can occur after isolated seizures.
- TPMA are characterized by reversible MRI signal changes in the brain following epileptic seizures.
- This case highlights TPMA in a pediatric patient with epilepsy and Apert syndrome.
Observation:
- A 1-year-old girl with Apert syndrome and epilepsy presented with MRI abnormalities.
- Abnormalities included hyperintensities on DWI and hypointensities on ADC maps in the left temporal, occipital, parietal lobes, and left thalamus.
- These findings resolved completely on follow-up MRI after 3 days.
Findings:
- The observed MRI signal changes were confirmed as TPMA after excluding other potential causes.
- Complete reversal of abnormalities on follow-up MRI supports the diagnosis of TPMA.
- Withdrawal of treatment led to immediate recovery and normalization of MRI findings.
Implications:
- TPMA should be considered in the differential diagnosis of young children presenting with seizures and neurological abnormalities.
- Recognition of TPMA is crucial for accurate diagnosis and appropriate management in pediatric epilepsy.
- The characteristic distribution of signal changes involving cortico-subcortical areas and the ipsilateral thalamus may aid in TPMA diagnosis.
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