MRI abnormalities associated with partial status epilepticus

Abstract

The radiologic characteristics of status epilepticus resemble those of ischemic stroke but can be differentiated based on lesion location and findings on MRA and postcontrast MRI. The MRI abnormalities indicated the presence of cytotoxic and vasogenic edema, hyperperfusion of the epileptic region, and alteration of the leptomeningeal blood-brain barrier. These changes reversed, but they resulted in some regional brain atrophy.

Unilateral cortical necrosis following status epilepticus with hypoglycemia

“…However in contrast to ischemia, the distribution of lesions following status epilepticus did not respect vascular territories, in accordance with our findings. Furthermore Lansberg et al [20] noted marked cortical hyperintensity on T2 throughout the affected hemisphere in all cases, similar to our results. Post-contrast leptomeningeal enhancement in focal status epilepticus may reflect hyperaemia from vasodilatation of leptomeningeal vessels.…”

“…Subsequent cortical enhancement is probably due to altered blood-brain barrier permeability, as demonstrated in a rat model [21] or in acute ischemic stroke [22]. Hyperperfusion of the affected hemisphere during SE is an ictal phenomenon in response to elevated metabolic demands usually followed by hypoperfusion and hypometabolism [20,23], as documented by our patients' interictal PET findings. However while these abnormalities resolved in patients with isolated SE whose follow-up scans showed only mild residual volume loss [20], they persisted in the children we describe.…”

“…Differences in patterns of cerebral involvement between SE and ischemia [18,19] have not been consistently documented. Certain similarities in MRI findings between partial status epilepticus in adults and ischemic stroke [20] have been described. These consisted of areas of decreased signal intensity on T1 with effacement of sulci, loss of graywhite matter differentiation and leptomeningeal enhancement on post contrast MRI.…”

Transient Occipitotemporal Subcortical Diffusion-Weighted Magnetic Resonance Imaging Abnormalities Associated With Status Epilepticus-Case Report-

“…In fact, the clarity of the lesion on MR imaging has been correlated with the prognosis for postoperative seizure control, with more diffuse lesions associated with poorer prognosis. 2,4,7,11,12) Furthermore, more recent methods of functional imaging such as positron emission tomography, single photon emission computed tomography, magnetic source imaging, and MR spectroscopy have all shown promise for use in the planning of epilepsy surgery as well as evaluation of patients with medically refractory seizures. 13) Diffusion-weighted MR imaging shows the random movement of water as low intensity due to spin dephasing, and restricted movement of water as higher intensity.…”

Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study

“…, although these fi ndings in nonconvulsive status epilepticus (NCSE) are exceptional 3,4 . Focal NCSE occurs mostly as complex partial status epilepticus (CPSE) and several articles have reported transient MRI abnormalities after such situation 5,6 . We report a case of a young female who presented a unique, long-lasting series of partial seizures with marked transient MRI abnormalities, followed by localized brain atrophy in despite of complete clinical recovery.…”