Features of acute DWI abnormalities related to status epilepticus

Chatzikonstantinou, Anastasios; Gass, Achim; Förster, Alex; Hennerici, Michael G.; Szabo, Kristina

doi:10.1016/j.eplepsyres.2011.07.002

Cited by 115 publications

(91 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Diffuse CDR is most frequently seen after hypotension or hypoxia, which our patient did not experience. Such findings have also been described in both HE and SE (Milligan et al (2009), Chatzikonstantinou et al (2011), U-King-Im et al (2011), and Bindu et al (2009), but not to the extent seen in our patient. Additionally, our patient had distinct radiologic features of both disease processes, suggesting a cumulative effect.…”

supporting

confidence: 43%

“…Conventional T2 weighted MRI sequences often show hyperintensity, representing cerebral edema [4]. The diffusion restriction and edema associated with seizure can involve an entire cerebral hemisphere without respecting vascular territories or, in up to 15%, involve bilateral hemispheres, even in patients with a unilateral seizure focus on EEG [5][6][7]. The most common areas of MRI abnormality after SE are the temporal lobe, in particular the hippocampus, any lobe of the neocortex, and the thalamus.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hyperammonemic Encephalopathy with Diffuse Cortical and Thalamic Signal Changes on Diffusion-Weighted Brain MRI

Yoon¹,

Choi²,

Kim³

2016

J Neurocrit Care

View full text Add to dashboard Cite

Comorbid hyperammonemic encephalopathy (HE) and status epilepticus (SE) leading to extensive cortical diffusion restriction (CDR) on MRI have not been previously reported. We describe a patient with HE who subsequently developed provoked SE. Sequential MRIs demonstrated a progressive CDR that involved the entire bilateral supratentorial cortex, thalami, and basal ganglia, resulting in death from cerebral edema and brain herniation. Diffuse CDR is most frequently seen after hypotension or hypoxia, which our patient did not experience. Such findings have also been described in both HE and SE (Milligan et al. (2009), Chatzikonstantinou et al. (2011), U-King-Im et al. (2011), and Bindu et al. (2009), but not to the extent seen in our patient. Additionally, our patient had distinct radiologic features of both disease processes, suggesting a cumulative effect. The diagnosis of HE and SE in the setting of extensive CDR should not be missed and could lead to improved outcomes for two progressive, malignant, and treatable illnesses that can be easily overlooked. Case ReportWe present a 50-year-old female with cirrhosis secondary to chronic hepatitis C and alcohol abuse in remission who was admitted to our hospital with a three-day history of worsening abdominal pain and confusion. She was prescribed lactulose for the hepatic encephalopathy, which kept her ammonia in the normal range but had missed several doses over the preceding three days in addition to a decrease in the number of bowel movements. On initial exam the patient was normotensive and oxygenating well on room air with mild encephalopathy. A chronic ventral hernia displayed no signs of peritonitis. Labs on admission were significant for an ammonia level of 87 mol/L (18-72 mol/L), platelet level of 96 k/ L, sodium of 132 mmol/L, and international normalized ratio (INR) of 1.6. Computed tomography of her abdomen and pelvis with intravenous contrast revealed that the hernia contained dilated small bowel but no definitive obstruction.Overnight her mental status declined and by the next morning she was difficult to arouse and unable to follow commands. Vitals were within normal limits and morning labs were significant for a rise in plasma ammonia to 277 mol/L. She was electively intubated for airway protection but was not hypoxic. The following morning, on hospital day 3, she developed rhythmic clonic facial movements with eyelid fluttering, sustained tonic stiffening of the extremities, and intermittent right upper extremity jerks. The neurology service was consulted and continuous electroencephalogram (EEG) was recommended. During two hours of recording, prior to MRI imaging, there was focal status epilepticus in the left temporal region that spread to the left central and right temporal regions. 5 mg of intravenous lorazepam was administered and 1 gm levetiracetam twice daily was started, but the EEG continued to show persistent SE. She was paralyzed with vecuronium to obtain MRI of the brain with gadolinium contrast. This revealed extensive CDR involving the b...

show abstract

supporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Hyperammonemic Encephalopathy with Diffuse Cortical and Thalamic Signal Changes on Diffusion-Weighted Brain MRI

Yoon¹,

Choi²,

Kim³

2016

J Neurocrit Care

View full text Add to dashboard Cite

show abstract

“…Chatzikonstantinou et al reported the most common localization of DWI abnormalities associated with ictal activity in SE was the hippocampus and the pulvinar. They found that combined DWI and EEG analysis provided clues to seizure localization and propagation [16]. Milligan et al studied the frequency and patterns of MRI abnormalities due to SE.…”

Section: Discussionmentioning

confidence: 98%

“…Most of the studies investigated patients with SE. Studies of patients with SE showed that MR imaging findings included increased signal intensity on T2-weighted images and DWI, gyral swelling, and gyral contrast enhancement [14][15][16]. Moreover, the topography of the SCM of complex partial SE (CPSE) was discussed in the following study.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of seizure-induced signal changes on MRI in patients with first seizures

Kim

Lee

Shin

et al. 2017

Seizure

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Gauging the Response To Treatmentmentioning

confidence: 99%

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

Rosenthal

2012

Neurotherapeutics

View full text Add to dashboard Cite

Neuromonitoring is an emerging field that aims to characterize real-time neurophysiology to tailor therapy for acute injuries of the central nervous system. While cardiac telemetry has been used for decades among patients requiring critical care of all kinds, neurophysiology and neurotelemetry has only recently emerged as a routine screening tool in comatose patients. The increasing utilization of electroencephalography in comatose patients is primarily due to the recognition of the common occurrence of nonconvulsive seizures among comatose patients, the development of quantitative measures to detect regional ischemia, and the appreciation of electroencephalography phenotypes that indicate prognosis after cardiac arrest. Other neuromonitoring tools, such as somatosensory evoked potentials have a complementary role, surveying the integrity of the neuroaxis as an indicator of prognosis or illness progression in both acute brain and spinal injuries.

show abstract

Features of acute DWI abnormalities related to status epilepticus

Cited by 115 publications

References 30 publications

Hyperammonemic Encephalopathy with Diffuse Cortical and Thalamic Signal Changes on Diffusion-Weighted Brain MRI

Hyperammonemic Encephalopathy with Diffuse Cortical and Thalamic Signal Changes on Diffusion-Weighted Brain MRI

Characteristics of seizure-induced signal changes on MRI in patients with first seizures

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

Contact Info

Product

Resources

About