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Claustrum Sign: An Increasingly Recognized Imaging Feature of New-Onset Refractory Status Epilepticus (NORSE).

Mohammad Abdullah¹, Tychicus Chen¹

¹Department of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

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|December 8, 2025

Summary

The claustrum sign on MRI may indicate new-onset refractory status epilepticus (NORSE). Early identification of this imaging finding can prompt aggressive treatment for a potentially refractory disease course.

Keywords:

claustrum epilepsy neuroradiology < clinical specialty status epilepticus < epilepsy

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Area of Science:

Neurology
Neuroradiology
Epilepsy

Background:

New-onset refractory status epilepticus (NORSE) presents a significant clinical challenge.
The claustrum sign, characterized by increased MRI signal intensity in the claustrum, is an emerging imaging biomarker.
This sign may correlate with disease severity and treatment resistance in NORSE.

Purpose of the Study:

To highlight the diagnostic significance of the claustrum sign in NORSE.
To emphasize the potential of early recognition for guiding treatment strategies.
To report a case of NORSE with early MRI evidence of the claustrum sign.

Main Methods:

Case report of a 42-year-old male patient with NORSE.
Review of clinical presentation, treatment course, and MRI findings.
Focus on the early appearance and implications of the claustrum sign.

Main Results:

The patient presented with NORSE refractory to multiple treatments, including immunotherapy.
MRI revealed the claustrum sign early in the disease progression.
The claustrum sign was associated with a refractory disease course.

Conclusions:

The claustrum sign is a valuable imaging feature in NORSE.
Early detection of the claustrum sign can alert clinicians to the diagnosis.
Prompt recognition may facilitate earlier and more aggressive therapeutic interventions for improved outcomes.