Multiple reversible MRI abnormalities associated with SESA syndrome

Abstract

The authors report the imaging findings in a patient with a long history of alcoholism, who presented with delirium and recurrent left hemiparesis meeting the criteria of subacute encephalopathy with seizures in alcoholics (SESA) syndrome. MRI revealed fully reversible signal intensities (T2, diffusion-weighted imaging with a decreased apparent coefficient) throughout the right hemisphere. This case suggests that the MRI characteristics of SESA syndrome resemble those of status epilepticus.

Neuroimaging features in subacute encephalopathy with seizures in alcoholics (SESA syndrome)

“…In 2008, Bugnicourt et al [8] first described a single case with transient MRI abnormalities resembling those of status epilepticus: focal cortical hyperintensities on T2 and FLAIR sequences, with restricted diffusion and leptomeningeal enhancement. In 2014, Choi et al presented two patients with SESA syndrome.…”

“…Following this definition, we decided to exclude 2 cases from the previous literature that were not characteristic for SESA syndrome, and had included patients with other neurological processes. We have taken this choice in order to reach a more pure group of patients with SESA in this review: i) The patient described by Bugnicourt et al [8] had a right hemispheric stroke involving a large vascular territory on the side of PLDs. The resultant encephalomalacia would be highly epileptogenic, a very common cause of focal seizures in adults.…”

An Atypical Presentation of Subacute Encephalopathy with Seizures in Chronic Alcoholism Syndrome

“…SESA syndrome usually presents with NCSE, often not associated with apparent symptoms of seizures. 2 , 3 EEG provides an important clue to correct diagnosis. In our patient, there was no laboratory abnormality on serologic test and cerebrospinal fluid analysis to cause the symptoms.…”

“…Focal lesions found in SESA syndrome are considered secondary to focal seizure activity because they are reversible and are similar to those observed in complex partial status epilepticus. 2 Patients with SESA syndrome should be treated with anti-epileptic drugs because of high risk of seizure recurrence. 3 The question remains whether SESA syndrome is a distinct disease entity or merely a coincidental presentation of partial NCSE in chronic alcoholic patients with underlying epileptogenic foci.…”

Subacute Encephalopathy With Seizures in Alcoholics Syndrome: A Subtype of Nonconvulsive Status Epilepticus

“…Surprisingly, few cases of SESA syndrome have been reported in the English literature since these early reports. 4–15 When initially described, the cause of delirium remained speculative and early authors assumed a vascular etiology. 2…”