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Acute postictal cerebral imaging

A M Silverstein1, J A Alexander

  • 1Section of Radiology, Crawford Long Hospital, Atlanta, GA 30365, USA.

AJNR. American Journal of Neuroradiology
|October 8, 1998
PubMed
Summary
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Brain imaging in postictal patients reveals reversible abnormalities like gyral swelling and enhancement. These findings, particularly in the frontal lobes, help differentiate seizure-related changes from other neurological conditions.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Postictal imaging aims to identify seizure causes like lesions.
  • Seizure activity itself can induce physiological or pathological brain alterations.
  • Understanding these postictal changes is crucial for accurate diagnosis.

Purpose of the Study:

  • To determine brain imaging findings in patients experiencing the immediate postictal period.
  • To correlate imaging results with altered mental status or weakness following seizures.

Main Methods:

  • Retrospective review of imaging (CT and MR) in ten patients within 12 hours of seizure.
  • Contrast material administered in some CT and MR studies.
  • Follow-up imaging performed from 1 day to 11 months later.

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Main Results:

  • Common CT findings included focal gyral swelling (10/10) and decreased gyral attenuation (8/9).
  • Contrast-enhanced CT showed mild to moderate gyral enhancement (5/5).
  • MR imaging revealed gyral swelling, increased T2 signal, and contrast enhancement, predominantly in frontal lobes.

Conclusions:

  • Postictal imaging can reveal reversible abnormalities such as gyral swelling and enhancement.
  • These findings, when reversible and clinically correlated, narrow differential diagnoses.
  • Distinguishing postictal changes from infarction, neoplasm, or inflammation is key.