Diffusion‐weighted magnetic resonance imaging in patients with partial status epilepticus

Abstract

SummaryPurpose: Diffusion-weighted magnetic resonance imaging (DWI) is used to detect changes in the distribution of water molecules in regions affected by various pathologies. Like other conditions, ictal epileptic activity, such as status epilepticus (SE), can cause regional vasogenic/cytotoxic edema that reflects hemodynamic and metabolic changes. This study describes the electroclinical and neuroimaging findings in 10 patients with partial SE whose DWI evaluation disclosed periictal changes related to sustained epileptic activity. Patients and Methods: In this retrospective study we selected 10 patients with partial SE of different etiologies (six acute symptomatic SE; four with previous epilepsy and concomitant precipitating factors) who underwent video-EEG (electroencephalography) monitoring and a DWI study during the periictal phase. We analyzed ictal electroclinical features and DWI changes in the acute phase and during the follow-up period. Results: DWI images revealed significant signal alterations in different brain regions depending on the location of ictal activity. DWI changes were highly concordant with the electroclinical findings in all 10 patients. As the SE resolved and the clinical conditions improved, DWI follow-up showed that the signal alterations gradually disappeared, thereby documenting their close relationship with ictal activity. Conclusions: This study confirms the usefulness of DWI imaging in clinical practice for a more accurate definition of the hemodynamic/metabolic changes occurring during sustained epileptic activity.

Symptomatic nonconvulsive status epilepticus erroneously suggestive of sporadic Creutzfeldt–Jakob disease

“…The involvement of cortical and pulvinar regions has been described in both sCJD and symptomatic SE [9]. These MRI abnormalities induced by periictal vasogenic and cytotoxic edema may completely normalize within weeks in SE [3] and they may disappear later in sCJD [9,11]. Therefore, in our case the reversible radiological findings did not allow to clearly discriminate SE from sCJD.…”

Diffusion-Weighted Imaging for the Differential Diagnosis of Disorders Affecting the Hippocampus

“…On follow-up MRI, slight DWI hyperintensity was still noted in 4 patients, whereas in the remaining patients, DWI abnormalities resolved gradually and had normalized on follow-up MRI performed after 2 weeks or later [40]. In contrast to these findings, Bonaventura et al [41 ]detected hippocampal diffusion changes in only 2 out of 10 patients with complex partial status epilepticus, although DWI revealed signal alterations in all patients. Similarly, these signal changes had resolved completely on follow-up MRI.…”

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

“…Neuron-specific enolase [97][98][99] and diffusion-weighted imaging [100][101][102] have been promulgated as biomarkers, which may detect nonconvulsive or complex partial status epilepticus; however, neither has been shown to be a reliable marker for anti-seizure medication titration in status epilepticus or in determining which periodic or stimulus-induced patterns on the ictal-interictal continuum should be treated. Cerebral microdialysis for the detection of elevated lactate or lactate:pyruvate ratio may help detect subtle seizures that surface EEG may miss [103].…”