Comparative Evaluation of Concomitant Structural and Functional Neuroimages in Rasmussen's Encephalitis

Fogarasi, András; Hegyi, Márta; Neuwirth, Magdolna; Halász, Péter; Barsi, Péter; Farkas, Viktor; Bognár, László

doi:10.1177/1051228403258083

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Although MCD may still be difficult to appreciate, especially in infants (Peacock et al., 1996; Duchowny et al., 1998; Edwards et al., 2000), fluid‐attenuated inversion recovery (FLAIR) imaging has improved its detection (Edwards et al., 2000; Lenclos et al., 2000). Contralateral abnormalities have also been noted in hemispherectomy candidates with focal MCD and coexistent periventricular leukomalacia (Villemure & Mascott, 1995; Edwards et al., 2000; Kossoff et al., 2003), Sturge‐Weber syndrome (Tuxhorn & Pannek, 2002), and Rasmussen’s encephalitis (Andermann & Rasmussen, 1991; Koehn & Zupanc, 1999; Fogarasi et al., 2003). As our sensitivity for appreciating contralateral MRI abnormalities increases, it is especially important to understand their implication for a surgery decision.…”

Section: Discussionmentioning

confidence: 99%

Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy

Hallböök¹,

Ruggieri²,

Adina³

et al. 2010

Epilepsia

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SUMMARYPurpose: To assess the impact of contralateral magnetic resonance imaging (MRI) findings on seizure outcome after hemispherectomy for refractory epilepsy. Methods: We retrospectively reviewed 110 children, 0.4-18 (median 5.9) years of age, who underwent hemispherectomy for severe refractory epilepsy at Cleveland Clinic Children's Hospital. In children with contralateral (as well as ipsilateral) MRI findings appreciated preoperatively, the decision to proceed to surgery was based on other features concordant with the side with the most severe MRI abnormality, including ipsilateral epileptiform discharges, lateralizing seizure semiology, and side of hemiparesis. Results: We retrospectively observed contralateral MRI abnormalities (predominantly small hemisphere, white matter loss or abnormal signal, or sulcation abnormalities) in 81 patients (74%), including 31 of 43 (72%) with malformations of cortical development (MCD), 31 of 42 (73%) with perinatal injury from infarction or hypoxia, and 15 of 25 (60%) with Rasmussen's encephalitis, Sturge-Weber syndrome, or posttraumatic encephalomalacia. Among 84 children (76%) with lesions that were congenital or acquired pre-or perinatally, 67 (83%) had contralateral MRI abnormalities (p = 0.02). Contralateral findings were subjectively judged to be mild or moderate in 70 (86%). At follow-up 12-84 (median 24) months after surgery, 79% of patients with contralateral MRI abnormalities were seizure-free compared to 83% of patients without contralateral MRI findings, with no differences based on etiology group or type or severity of contralateral MRI abnormality. Discussion: MRI abnormalities, usually mild to moderate in severity, were seen in the contralateral hemisphere in the majority of children who underwent hemispherectomy for refractory epilepsy due to various etiologies, especially those that were congenital or early acquired. The contralateral MRI findings, always much less prominent than those in the ipsilateral hemisphere, did not correlate with seizure outcome and may not contraindicate hemispherectomy in otherwise favorable candidates.

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Section: Discussionmentioning

confidence: 99%

Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy

Hallböök¹,

Ruggieri²,

Adina³

et al. 2010

Epilepsia

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“…SPECT findings of CCD have been described in patients with RE whereas its correlate on MRI has been seldom reported [6][7][8][9][10].…”

Section: Dear Sirsmentioning

confidence: 95%

MRI findings of crossed cerebellar diaschisis in a case of Rasmussen’s encephalitis

et al. 2010

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“…It is possible that reorganization of somatosensory cortex helps to maintain functions, in spite of the anatomical damage. caudate atrophy occurred in all our patients, although this has been rarely reported [21][22][23] . Patients with hemiparesis and more frequent seizures presented also gray and focal white matter hyperintensity in T2-weighted images.…”

Section: Discussionmentioning

confidence: 45%

MRI findings in the diagnosis and monitoring of rasmussen's encephalitis

Faria

Reis

Dabus

et al. 2009

Arq. Neuro-Psiquiatr.

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-Rasmussen's encephalitis is a devastating syndrome of multifocal brain dysfunction and focal seizures. Magnetic resonance (MR) findings, associated with clinical data and electroencephalogram (EEG), may indicate the diagnosis and could be an indicative of prognosis. We studied 5 patients with Rasmussen's encephalitis, assessing clinical history and MR images. All patients had refractory focal seizures with a predominant motor component associated with hemispheric atrophy, that was proportional to severity of disease and neurological deficits in these patients. Gray and white matter abnormal signal on T2 MR images were found in patients who had hemiparesis. It was not related to the duration of the disease but to aggressiveness. MR proton spectroscopy in severe disease showed lactate and choline increase and decreased NAA, reflecting neuronal and axonal loss, gliosis and elevated membrane turnover and recent -crisis (not controlled). MR studies, in addition to help in diagnosis, may be useful for monitoring metabolic changes and progression of disease in Rasmussen's encephalitis.KEy WoRds: Rasmussen's encephalitis, MRI, spectroscopy, epilepsy. Achados de RM no diagnóstico e monitorização da encefalite de RasmussenResumo -A encefalite de Rasmussen é uma devastadora síndrome com disfunção cerebral multifocal e convulsões focais. Achados de ressonância magnética (RM), associados aos dados clínicos e de eletrencefalograma (EEG), podem indicar o diagnóstico e podem ser indicativos de prognóstico. Foram estudados 5 pacientes com encefalite de Rasmussen, avaliando a história clínica e imagens de RM. Todos os pacientes apresentavam crises epilépticas focais refratárias com componente predominantemente motor associadas à atrofia hemisférica, que foi proporcional à gravidade da doença e déficits neurológicos nestes pacientes. Alteração da intensidade de sinal nas substâncias branca e cinzenta, nas sequências ponderadas em T2, foram encontradas nos pacientes com hemiparesia. Ela não estava relacionada com a duração da doença, mas à severidade. A espectroscopia de prótons por RM na doença severa demonstrou aumento dos níveis de colina e lactato e diminuição de N-acetilaspartato, refletindo perda neuronal e axonal, gliose e aumento de turnover de membrana e crise recente (não controlada). Estudos de RM, além de ajudar no diagnóstico, podem ser úteis para acompanhar alterações metabólicas e progressão da doença na encefalite de Rasmussen.PAlAvRAs-chAvE: encefalite de Rasmussen, RM, espectroscopia, epilepsia.

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Comparative Evaluation of Concomitant Structural and Functional Neuroimages in Rasmussen's Encephalitis

Abstract: Concomitant structural and functional neuroimaging provide possibly complementary information in the early noninvasive workup of RE and may facilitate the early diagnosis of this rare disorder.

Cited by 5 publications

References 17 publications

Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy

Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy

MRI findings of crossed cerebellar diaschisis in a case of Rasmussen’s encephalitis

MRI findings in the diagnosis and monitoring of rasmussen's encephalitis

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