MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

Kim, Na Yoon; Baek, Hye Jin; Choi, Dae Seob; Ha, Jee Young; Shin, Hwa Seon; Kim, Ju Ho; Choi, Ho Cheol; Kim, Ji Eun; Park, Mi Jung

doi:10.13104/imri.2017.21.2.82

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…Postictal edema may be present in imaging done immediately after seizure episode or with status epilepticus. 33,34 In two patients of our series, isolated subcortical white matter edema was noted without any other findings (►Fig. 13).…”

Section: Postictal Edemamentioning

confidence: 73%

Magnetic Resonance Imaging in Peripartum Encephalopathy: A Pictorial Review

Manjubashini

Nagarajan

Amuthabarathi

et al. 2021

JNRP

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Acute neurological problems are significant disorders of pre- and postpartum period in women. We analyzed the magnetic resonance imaging (MRI) profile of patients presenting with peripartum encephalopathy over 2 years. Of 51 patients, MRI was abnormal in 40 patients and normal in 11 patients. Posterior reversible encephalopathy (13/40), cerebral venous thrombosis (6/40), and postpartum angiopathy (3/40) are the three most common causes of peripartum encephalopathy as identified in MRI. The other less common but important etiology include HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet) syndrome (2), osmotic demyelination (2), antiphospholipid syndrome (2), tubercular meningitis/cerebritis (3), pituitary hyperplasia with hemorrhage (2), postictal edema (2), cerebellitis (1), transient splenial lesion (1), and changes of old trauma and stroke (one each).

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Section: Postictal Edemamentioning

confidence: 73%

Magnetic Resonance Imaging in Peripartum Encephalopathy: A Pictorial Review

Manjubashini

Nagarajan

Amuthabarathi

et al. 2021

JNRP

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“…This creates a relative mismatch between consumption and delivery of metabolites 11 triggering reactive hyperperfusion to the brain region. 16 Eventually, the Na+/K+-ATPase pump fails, resulting in an influx of sodium ions and water into the neuron, causing cytotoxic edema. The cortex, with higher energy demands than the underlying white matter, shows preferential involvement, 17 while the white matter exhibits vasogenic edema, producing the split ADC sign.…”

Section: Discussionmentioning

confidence: 99%

The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis

Ludovichetti,

Nierobisch,

Achangwa

et al. 2023

Neuroradiol J

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Introduction MRI is the imaging modality of choice for assessing patients with encephalopathy. In this context, we discuss a novel biomarker, the “split ADC sign,” where the cerebral cortex demonstrates restricted diffusion (high DWI signal and low ADC) and the underlying white matter demonstrates facilitated diffusion (high or low DWI signal and high ADC). We hypothesize that this sign can be used as a biomarker to suggest either acute encephalitis onset or to raise the possibility of an autoimmune etiology. Materials and Methods A full-text radiological information system search of radiological reports was performed for all entities known to produce restricted diffusion in the cortex excluding stroke between January 2012 and June 2022. Initial MRI studies performed upon onset of clinical symptoms were screened for the split ADC sign. Results 25 subjects were encountered with a positive split ADC sign (15 female; median age = 57 years, range 18–82). Diagnosis included six herpes simplex encephalitis, three peri-ictal MRI changes, eight PRES, two MELAS, and six autoimmune (3 anti-GABAAR, two seronegative, and one anti-Ma2/Ta). Subjects were imaged at a mean 1.8 days after the onset of symptoms (range 0–8). Discussion We present a novel visual MRI biomarker, the split ADC sign, and highlight its potential usefulness in subjects with encephalopathy to suggest acute disease onset or to raise the possibility of an autoimmune etiology when location-based criteria are applied. When positive, the sign was present on the initial MRI and can therefore be used to help focus further clinical and laboratory workup.

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“…However, Signh et al reported that restricted diffusion was found only 45.5% of reported patients. There has been no clear explanation of the MR signal changes related to the seizure [ 13 – 15 ]. However, restricted diffusion on MR is usually associated with acute cerebral infarction, neoplasms, intracranial infections, traumatic brain injury, and status with demyelination processes [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Follow-Up of Brain Single-Photon Emission Computed Tomography (SPECT) and Magnetic Resonance Imaging (MRI) in a Case of Seizure Caused by Osmotic Demyelination Syndrome

Chong

Chung

et al. 2020

Am J Case Rep

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Patient: Male, 38-year-old Final Diagnosis: Osmotic demyelination syndrome Symptoms: Seizure Medication: — Clinical Procedure: — Specialty: Nuclear Medicine • Radiology Objective: Challenging differential diagnosis Background: Osmotic demyelination syndrome (ODS) is an uncommon neurological disorder. Until the mid-1980s, the mortality rate was 90–100%, but more than half of patients now have a good prognosis. Early suspicion of ODS is important. However, radiologic findings of ODS are variable and scintigraphy findings have not been reported. Case Report: A 38-year-old man with alcohol abuse history was admitted due to electrolyte imbalance. On the 10 th day of his hospital stay, he had a generalized tonic-clonic seizure. Brain perfusion SPECT showed asymmetrically hyper-perfused and hypoperfused lesions. Brain MRI revealed diffuse T2 hyperintensity with mild diffusion restriction in the pons and hyperperfused lesions on brain SPECT. He was treated based on the diagnosis of hyponatremia and osmotic demyelination. After treatment, the asymmetric hyperperfusion was decreased. MRI showed that the cortical hyperintensity had resolved, with encephalomalacic change shown in the pons. Conclusions: To the best of our knowledge, this is the first report showing changes in brain perfusion SPECT and MRI in an ODS patient with a seizure. This case report may be helpful to neurologists, radiologists, and nuclear physicians.

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MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

Cited by 5 publications

References 24 publications

Magnetic Resonance Imaging in Peripartum Encephalopathy: A Pictorial Review

Magnetic Resonance Imaging in Peripartum Encephalopathy: A Pictorial Review

The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis

Follow-Up of Brain Single-Photon Emission Computed Tomography (SPECT) and Magnetic Resonance Imaging (MRI) in a Case of Seizure Caused by Osmotic Demyelination Syndrome

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