Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI)

Abstract

• The focal ictal brain regions show hyperperfusion in DSC MR-perfusion imaging. • SWI shows focally diminished cortical veins in hyperperfused ictal regions. • SWI has the potential to identify a focal ictal region in CSE/NCSE.

Susceptibility‐weighted imaging in acute‐stage pediatric convulsive disorders

“…A recently published report described an association of regional pseudo-narrowed or pseudo-diminished cortical veins in SWI and regional hyperperfusion in dynamic susceptibility contrast (DSC) MRI with ictal and post-ictal abnormalities on EEG. 7 In contrast, the present study demonstrated regionally prominent cortical veins in SWI associated with abnormalities on inter-ictal EEG. Blood oxygen level-dependent (BOLD) signals depend on cerebral blood flow (CBF), cerebral blood volume (CBV), and cerebral metabolic rate of oxygen (CMRO 2 ).…”

“…10 We speculate that sufficiently strong seizures and concomitant increased CMRO 2 in the brain might result in decreased BOLD response and possible hypoxia under some circumstances. The present observations, along with recently published reports, 5,7 suggest a complex, non-linear relationship between BOLD signal and hemodynamic and neuronal activity under pathologic circumstances. We speculate that the simultaneous use of MRA with SWI could facilitate understanding of the correlation between cerebral perfusion and intravascular deoxygenated hemoglobin concentration in epileptic foci during the acute stage of convulsive disorders.…”

“…Although SWI is broadly accepted as a useful method to monitor stroke, trauma, vascular malformations, and tumors, 4 the clinical use of SWI in patients with acute prolonged seizures was reported in only two case reports with opposite SWI findings 5,6 and in one case series, 7 and the clinical significance of SWI in seizure disorders remains unclear.…”

Neuroimaging alterations related to status epilepticus in an adult population: Definition of MRI findings and clinical‐EEG correlation

“…18,27 In our population, acute/subacute MRI changes were present in only 12% of the patients studied with MRI during or after an episode of SE. 18,27 In our population, acute/subacute MRI changes were present in only 12% of the patients studied with MRI during or after an episode of SE.…”

“…Incidence of SE-related MRI signal alterations in retrospective series varies between 11.6% and 50%. 18,27 In our population, acute/subacute MRI changes were present in only 12% of the patients studied with MRI during or after an episode of SE. This low proportion is related mostly to the fact that only 35% of the patients received an MRI study during SE and most investigations were performed after cessation of the study.…”