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Introducing the "Temporal Thumb Sign" in Pediatric Patients With New-Onset Idiopathic Seizures With and Without
Arash Kamali1, Evelyn S Park2, Seung A Lee2
1Division of Neuroradiology, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas.
Insights
The "temporal thumb sign" (TTS) is a newly identified MRI finding in pediatric patients. This sign is significantly associated with seizures and elevated intracranial pressure, showing high sensitivity and specificity.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Anterior temporal lobe abnormalities can be epileptogenic foci in children.
- The
- temporal thumb sign
- (TTS) is a posterior temporal skull base remodeling by the inferior temporal gyrus.
Purpose of the Study:
- To analyze the prevalence of TTS in pediatric patients with new-onset seizures and/or elevated opening pressure (OP).
- To compare TTS findings in patients with idiopathic intracranial hypertension (IIH) without seizures, patients with seizures, and healthy controls.
Main Methods:
- Retrospective analysis of MRI scans from 163 pediatric patients.
- Categorization into groups: IIH with elevated OP, new-onset seizures with elevated OP, new-onset seizures with normal OP, and healthy controls.
Main Results:
- TTS was most frequent in patients with seizures and elevated OP (72.5%).
- TTS was observed in 32.6% of IIH patients and 27.5% of seizure patients with normal OP.
- The control group showed TTS in 12.5% of cases.
- TTS demonstrated high sensitivity and specificity (72.5%) for seizures with elevated OP.
Conclusions:
- The Kamali
- temporal thumb sign
- is a novel imaging feature.
- TTS may serve as a sensitive and specific imaging biomarker for pediatric seizures associated with elevated OP.
Background:
Temporal lobe changes, such as anterior temporal lobe meningoceles or encephaloceles, have been documented as possible epileptogenic foci in a subset of pediatric patients with seizures. In our study, we aim to analyze a different structural change in the temporal lobe, remodeling of the posterior temporal skull base by the inferior temporal gyrus called the "temporal thumb sign" (TTS), in pediatric patients presenting with new-onset seizures with or without elevated opening pressure (OP), patients presenting with confirmed diagnosis of idiopathic intracranial hypertension (IIH) without seizure presentation, and healthy controls.
Methods:
Magnetic resonance imaging scans of 163 pediatric patients were studied retrospectively for the presence of TTS. We analyzed the scans of 43 patients with elevated OP and confirmed IIH, 40 patients with elevated OP and new-onset idiopathic seizures, 40 patients with normal OP and new-onset idiopathic seizures, and 40 age- and sex-matched healthy controls.
Results:
The TTS was detected most frequently in patients with elevated OP and seizures at 72.5% compared with patients with IIH with no seizures and patients with normal OP and seizures (32.6% and 27.5%, respectively). The TTS had a frequency of 12.5% in the control group. The TTS had the highest combination of specificity and sensitivity (72.5% and 72.5%) in patients with seizures and elevated OP compared with patients with seizures and normal OP (P value < 0.001).
Conclusions:
Our results suggest the Kamali "temporal thumb sign" is a novel imaging feature that may be used as a sensitive and specific imaging finding associated with seizures and elevated OP in the pediatric population.
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