Summary:Purpose: Transient increased T 2 signal in the splenium of the corpus callosum after seizures has been reported and sometimes attributed to a postulated toxicity of anticonvulsant medications (AEDs).Methods: We describe two patients with bitemporal epilepsy.Results: Transiently increased T 2 signal (in one) and decreased apparent diffusion coefficient (ADC) (in both) in the splenium appeared to be related directly to acute seizures. Conclusions:These cases illustrate an unusual acute postictal imaging finding, highlight involvement of an important commissural pathway, and suggest that seizures per se, and not their treatment, are the cause of transient white-matter abnormalities in these cases. Key Words: Splenium-Diffusion-weighted imaging-Magnetic resonance imaging.Magnetic resonance imaging (MRI) has revolutionized the evaluation of patients with seizures over the last two decades. Most MRI is obtained interictally to search for an underlying structural basis for epileptic discharge; recent attention has focused on the potential of MRI to reveal transient physiologic changes associated with abnormal neuronal activity. Here we present two patients who manifested transient changes in the splenium on diffusionweighted imaging (DWI) after repeated seizures. METHODSPatients reported in this study were evaluated by using conventional approaches for possible epilepsy surgery. MRI studies were obtained by using protocols that we have optimized for the evaluation of patients with suspected focal epilepsy. All patients were studied on a GE Signa CASE REPORTS Patient 1A 23-year-old man with an 11-year history of intractable epilepsy was admitted for presurgical evaluation. An MRI brain study on the day of admission was unremarkable. Antiepileptic medications (AEDs) were discontinued during video-EEG monitoring, which revealed very active independent bilateral anterior temporal interictal spikes, with an approximate ratio of 3:1, right to left. Multiple focal clinical seizures, many with secondary generalization, appeared to arise independently from both temporal lobes. A repeated MRI obtained 24 h after his last seizure to obtain more detailed images of the temporal lobes demonstrated an area of markedly increased signal on DWI and mildly increased T 2 signal in the splenium of the corpus callosum. The corresponding ADC map confirmed that there was decreased apparent diffusion of water. Four weeks later, after resumption of AED treatment, a follow-up MRI demonstrated resolution of the lesion (Fig. 1, top). Patient 2A 39-year-old man with a history of alcoholism and long-standing seizures presented for presurgical 852

To denote the metabolic imaging localization of seizure onset with ictal and interictal Neurolite single-photon emission computed tomographic scans and difference images made by subtracting activity at individual voxels of these images, which ultimately identify intense focal uptake in the trunk motor region and other, probably secondarily, propagated pathways. Design: Retrospective review of a unique case report. Setting: A suburban epilepsy referral center. Patient: A 59-year-old man with truncal-onset seizure. Interventions: Ictal and interictal metabolic imaging. Main Outcome Measures: Onset location of ictal events. Results: The patient had a gliotic lesion in a focal region on magnetic resonance imaging undercutting the trunk motor area in the cortex of the precentral gyrus with concordant single-photon emission computed tomographic imaging. Conclusions: While truncal-onset seizures have been described previously in a few case reports, they are clinically rare. As far as we know, this is the only case report in the literature in which metabolic imaging was carried out with this entity and is consistent with the anatomical localization of seizure onset in the trunk motor area.

Spinal cord infarction is an uncommon disease and as such is often a diagnostic challenge for clinicians. It can vary in its onset, severity, outcome, and recovery from patient to patient. Treatment options for this relatively rare condition also remain elusive. Current consensus recommendations are antiplatelet therapy and the symptomatic management of associated complications such as paraplegia and thromboembolic disease. There are multiple studies in surgical literature of a variety of interventions and adjuncts used for reducing the risk of ischemic spinal cord neurological injury, seen most often in the setting of thoracoabdominal aortic repair operations. We report two cases of acute non-surgical-related spinal cord infarcts, where early diagnosis was made and aggressive, early treatments instituted. With often devastating outcomes, we highlight the need for early detection and that interventions, commonly used in preventing neurological injury after high-risk aneurysm repairs, may be beneficial in treating and reducing the severity of disability in acute spinal cord stroke.

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Objectives: To highlight a case series of 3 cases of focal cortical dysplasia that were unrecognized for many years though the patients were seen by various neurologists and received the appropriate neuroimaging studies, and to retrospectively characterize the clinical elements, neuroimaging, electroencephalography, and pathologic findings in these cases. Design: Retrospective descriptive study. Setting: Tertiary urban and suburban neurology and epilepsy outpatient and inpatient clinic settings and hospitals. Patients: We analyze retrospectively 3 patients in whom magnetic resonance images were previously deemed as normal, who, in fact, exhibited subtle gyral abnormalities and who underwent focal surgical resections of these regions after invasive electroencephalography monitoring or electrocorticography and were cured of their epilepsy. Main Outcome Measures: Clinical semiology and neuroimaging findings. Results: Focal cortical dysplasias may present with subtle gyral abnormalities. These gyral abnormalities may guide invasive electroencephalography or electrocorticography and may delineate seizure onsets with precision. Resection of these areas in 3 such patients resulted in excellent surgical outcomes. Conclusions: Subtle gyral abnormalities may be associated with intractable epilepsy and seizure onsets. Focal resection after appropriate evaluations in selected patients may be curative. The magnetic resonance imaging features of focal cortical dysplasia can be subtle and require a high index of suspicion based on ictal semiology and clinical presentation.

Abstract-Objective:To investigate the association of an indicator of hippocampal function with severity of depression symptoms in temporal lobe epilepsy. Methods: We evaluated 31 patients with video/EEG-confirmed temporal lobe epilepsy using creatine/N-acetylaspartate ratio maps derived from a previously validated 1 H magnetic resonance spectroscopic imaging ( 1 H-MRSI) technique at 4.1 T. We also assessed depression symptoms, epilepsy-related factors, and self-perceived social and vocational disability. We used conservative nonparametric bivariate procedures to determine the correlation of severity of depression symptoms with imaging and clinical variables. Results: The extent of hippocampal 1 H-MRSI abnormalities correlated with severity of depression (Spearman rho ϭ 0.65, p value Ͻ 0.001), but other clinical factors did not. Conclusion: The extent of hippocampal dysfunction is associated with depression symptoms in temporal lobe epilepsy and may be a more important factor than seizure frequency or degree of disability.

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