The role of brain MRI in status epilepticus

Abstract

Magnetic Resonance Imaging (MRI) is increasingly being used as an investigation tool in status epilepticus (SE). It measures edema and cytotoxic edema that includes both cortical and/or subcortical constructions. The objective of our study is to identify the brain MRI changes that occur in patients with status epilepticus. A cross can aid in understanding ictal/postictal pathophysiology. Peri-ictal abnormalities may apparent as vasogenic -sectional analytic study conducted on patients with status epilepticus admitted to the emergency room or neurological ward at Al-Imamain AL-Kadhymain Medical City and AL-Yarmook Teaching Hospital for the period between January 2018 and January 2019. Brain MRI exam was performed for eligible patients using 3 Tesla MRI unit utilizing standard imaging protocol consisting of the following sequences: axial T2, coronal FLAIR, axial and/or sagittal T1, DWI and ADC maps with additional sequences tailored by the available clinical data and the imaging findings. Patients with positive MRI findings attributable to status were followed up by an MRI exam after 3 months. 28 patients were included in this study. The mean age of the patients was 40.6±18.4 years and the age range 18-80 years. Female to male ratio was 2.1:1. The frequency of MRI changes in SE patients was 3 out of 28 (10.7%). History of epilepsy was present among 28.6% of patients with SE. The primary etiology of status epilepticus for patients with MRI changes were a remote ischemic stroke for one patient and idiopathic etiology for the other two patients. Follow up MRI showed that two patients (66.7%) had reversible MRI changes, while one patient (33.35%) had mixed reversible and irreversible changes. A significant negative association was observed between the time interval from SE onset to MRI and the development of SE-related brain MRI changes (p=0.02). Our results show that 10.7 % of patients with status epilepticus had positive brain MRI changes attributable to status. The earlier an MR exam is performed for these patients, the more likely that MRI changes will be observed.