Focal Cerebral Magnetic Resonance Changes Associated with Partial Status Epilepticus

Abstract

We report 2 patients with transient abnormalities on magnetic resonance imaging (MRI) associated with partial status epilepticus (SE). A man with a 4-month history of partial seizures had complex partial SE for 9 days, with left temporal maximum on ictal EEG. Left temporal lobe T2 signal was increased on MRI during SE, but cerebral MRI was normal 9 weeks later. A woman with "cryptogenic" temporal lobe epilepsy for 16 years had complex partial SE for 1 week, with right temporal maximum on ictal EEG. T2 Signal was increased over the entire right temporal lobe, extending into the insula, without mass effect, on MRI 1 month after SE ended. Repeat MRI 1 month later showed marked decrease in volume of increased T2 intensity, without gadolinium enhancement, but with mild mass effect over the right anterioinferomesial temporal areas. A gemistocytic astrocytoma was resected. Focal cerebral MRI abnormalities consistent with cerebral edema may be due to partial SE but also may indicate underlying glioma, even in long-standing partial epilepsy. Focal structural imaging changes consistent with neoplasm should be followed to full resolution after partial SE.

MRI, 1H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity

“…[20][21][22][23][24] The resolution of the signal changes within 3 months, as seen in our patient, has been also reported in several other studies. 21,22,25 The signal hyperintensity may or may not be associated with gadolinium contrast enhancement and does not exhibit mass effect.…”

“…[20][21][22][23][24] The resolution of the signal changes within 3 months, as seen in our patient, has been also reported in several other studies. 21,22,25 The signal hyperintensity may or may not be associated with gadolinium contrast enhancement and does not exhibit mass effect. 23,24 Proposed mechanisms for these lesions include vasogenic edema reflecting altered permeability of the vessels in relation to seizures, which results in a breakdown of the bloodbrain barrier and fluid accumulation in the white matter within the extracellular space.…”

Reversible focal radiological changes due to non-convulsive status epilepticus of the right parietooccipital lobe - case report -

“…All the findings completely resolved upon follow-up 2 months later. Although similar findings have been reported in recent years (1,3,5,7,8), there are few reports referring to the MRA findings due to the status epilepticus (2). We want to indicate the reversible radiological alterations in MRA.…”

Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series

“…Many reports have demonstrated that nonconvulsive status epilepticus or frequent partial seizures may produce transient cortical edema, T2 hyperintensity, leptomeningeal or cortical enhancement, and permanent sequelae, including cortical laminar necrosis. [6][7][8][9] Postictal MR imaging findings in patients without prior radiation therapy appear different from SMART, suggesting that SMART may represent a unique syndrome with a complex poorly understood pathophysiology occurring in a subset of patients long after radiation therapy. 10,11 It may be that seizures in patients with SMART strain an already impaired brain because of the chronic endothelial vascular damage caused by remote radiation, and this "double hit" produces infarction in some instances in the affected cortical areas.…”