Subcortical Low-Intensity and Restricted Diffusion After First Seizure in a Child

Cerase, Alfonso; Leonini, Sara; Franceschini, Rossella; Grosso, Salvatore; Venturi, Carlo

doi:10.1097/rct.0b013e31821f5d14

Cited by 7 publications

(2 citation statements)

References 6 publications

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“…Ischemia or seizures without hyperglycemia can result in similar MRI abnormalities, indicating that subcortical T2 hypointensity is not specific to seizures associated with NKH [ 5 ]. However, many cases of seizure associated with NKH have been reported.…”

Section: Discussionmentioning

confidence: 99%

Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report

et al. 2016

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BackgroundNonketotic hyperglycemia often causes seizures. Recently, seizures associated with nonketotic hyperglycemia have been found to be associated with subcortical T2 hypointensity on magnetic resonance imaging, especially in the occipital lobes. However, the mechanism remains unclear, although iron accumulation is suggested. We present a case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the hypothesis that the mechanism of subcortical T2 hypointensity is iron accumulation using gradient-echo T2*-weighted magnetic resonance imaging.Case presentationA 65-year-old Japanese man complained of intermittent pastel-colored flashing lights. On neurological examination, he also had lower right-side quadrant hemianopia. No other abnormal neurological findings were found. On laboratory analysis, his blood glucose level was 370 mg/dL, HbA1c was 11.4 %, and serum osmolarity was 326 mOsm/L. No ketones were detected in urine. A magnetic resonance imaging scan of his head showed subcortical T2 and T2* hypointensity in his left occipital lobe. Single-photon emission computed tomography with I123-N-isopropyl-iodoamphetamine revealed hyperperfusion in the left dominant occipital lobe. These magnetic resonance imaging abnormalities resolved during clinical recovery and treatment to control his blood sugar level. Therefore, a diagnosis of occipital lobe seizures associated with nonketotic hyperglycemia was made.ConclusionsTo the best of our knowledge, this is the first case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the role of iron accumulation as a mechanism for subcortical T2 hypointensity using T2*-magnetic resonance imaging.

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Section: Discussionmentioning

confidence: 99%

Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report

et al. 2016

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“…It remains unclear why NKH results in localized regions of T2 hypointensity. Subcortical T2 hypointensity is not unique to NKH, and has been reported in the context of ischemia, revascularization, encephalitis and meningitis, leptomeningeal metastasis, focal seizures and Sturge‐Weber syndrome [15-18]. Several hypotheses have been put forward for this often transient subcortical T2 hypointensity, including free radical formation, iron deposition, and venous congestion [16, 19].…”

Section: Discussionmentioning

confidence: 99%

Location‐atypical lesions in non‐ketotic hyperglycemic epilepsy: expanding the clinico‐radiographic phenotype

Amar,

Bhattacharya,

Uzo‐Okereke

et al. 2022

Epileptic Disorders

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Non‐ketotic hyperglycemia (NKH) is associated with a spectrum of symptoms and radiographic findings due to poorly‐controlled diabetes mellitus. These lesions, which predominantly affect the parieto‐occipital cortex, are commonly missed by neurologists and neuroradiologists due to their subtle hypointense appearance on T2‐based imaging. We report four atypical cases of this syndrome to highlight its subtle, protean presentation in order to aid timely diagnosis. Based on our institutional case series, we describe four cases of NKH with atypical presentation and lesion burden affecting the anterior cortex. We review the clinical presentations, laboratory abnormalities, neuroimaging, and corresponding electroencephalography. Four patients with atypical NKH were characterized in our series. Presenting symptoms ranged from rhythmic handtapping to generalized tonic‐clonic status epilepticus. Laboratory values were notable for marked hyperglycemia (range: 447 – 627 mg/dL), mild pseudohyponatremia (range: 127 – 136 mmol/L), and elevated hemoglobin A1C levels (range: 10.9 16.1%). All patients were found to have the classically described pattern of T2‐based hypointensity; three with atypical distributions involving the “anterior” cortex. These lesions corresponded to the electrographic nidus of seizure burden. During follow‐up, both seizures and T2‐based hypointensity resolved within weeks of serum glucose normalization. Our series of four NKH patients with atypical findings of T2‐based signal abnormalities expands the clinico‐radiographic phenotype revealing a more protean distribution than previously described. Knowledge of these atypical imaging features will aid both the neurologist and radiologist in timely diagnosis and care of these patients.

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Seizure-induced brain lesions: A wide spectrum of variably reversible MRI abnormalities

Cianfoni

Caulo

Cerase

et al. 2013

European Journal of Radiology

181

138

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Subcortical Low-Intensity and Restricted Diffusion After First Seizure in a Child

Cited by 7 publications

References 6 publications

Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report

Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report

Location‐atypical lesions in non‐ketotic hyperglycemic epilepsy: expanding the clinico‐radiographic phenotype

Seizure-induced brain lesions: A wide spectrum of variably reversible MRI abnormalities

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