Restricted Diffusion on Magnetic Resonance Imaging in Partial Status Epilepticus

Reversible Cytotoxic Edema in a Cirrhotic Patient Following TIPS

“…Moreover, our patient made a substantial recovery over several days, which is in stark contrast to the dismal prognosis of patients with ischemic cortical laminar necrosis. Other conditions such as status epilepticus have been associated with findings of reversible cortical cytotoxic edema on brain MRI; however, in those reported cases the areas of involvement are distributed in a unilateral or asymmetric bilateral pattern, 6,7 which is in contrast to the symmetric distribution of findings in our patient. Meningoencephalitis caused by infectious pathologens such as herpesviruses have been shown to result in cortical cytotoxic edema; however, in our patient the findings were not limited to the limbic cortex as is most frequently reported in herpes encephalitis, 8 and our patient's clinical course was not consistent with infectious encephalitis and would not account for his recovery coinciding with treatment of hyperammonemia.…”

Reversible Cytotoxic Edema in a Cirrhotic Patient Following TIPS

“…Moreover, our patient made a substantial recovery over several days, which is in stark contrast to the dismal prognosis of patients with ischemic cortical laminar necrosis. Other conditions such as status epilepticus have been associated with findings of reversible cortical cytotoxic edema on brain MRI; however, in those reported cases the areas of involvement are distributed in a unilateral or asymmetric bilateral pattern, 6,7 which is in contrast to the symmetric distribution of findings in our patient. Meningoencephalitis caused by infectious pathologens such as herpesviruses have been shown to result in cortical cytotoxic edema; however, in our patient the findings were not limited to the limbic cortex as is most frequently reported in herpes encephalitis, 8 and our patient's clinical course was not consistent with infectious encephalitis and would not account for his recovery coinciding with treatment of hyperammonemia.…”

An exploration of the spectrum of peri-ictal MRI change; a comprehensive literature review

“…What has consistently been demonstrated over several studies is that the DWI changes identified in the peri-ictal period do not respect vascular neuroantatomical boundaries [19,54,92,109] which can be useful in identifying that the changes are ictal rather than vascular in origin.…”

“…Some points highlighted in the review have other practical clinical implications. Ictal related diffusion change on DWI does not respect vascular neuroanatomical boundaries [19,54,92,109]. These areas also demonstrate hyperperfusion on MRS or MRA which can be useful in identifying that the changes are ictal rather than ischaemic in origin in the emergent clinical setting.…”

“…It stands to reason that patients who display cortical diffusion restriction should have concordant EEG abnormalities [109]. The abnormalities described are broad and include PLEDs, focal slow wave activity (either delta or theta frequency) and focal spikes [20,32,77,110].…”

Reversible Cytotoxic Edema in a Cirrhotic Patient Following TIPS

“…Moreover, our patient made a substantial recovery over several days, which is in stark contrast to the dismal prognosis of patients with ischemic cortical laminar necrosis. Other conditions such as status epilepticus have been associated with findings of reversible cortical cytotoxic edema on brain MRI; however, in those reported cases the areas of involvement are distributed in a unilateral or asymmetric bilateral pattern, 6,7 which is in contrast to the symmetric distribution of findings in our patient. Meningoencephalitis caused by infectious pathologens such as herpesviruses have been shown to result in cortical cytotoxic edema; however, in our patient the findings were not limited to the limbic cortex as is most frequently reported in herpes encephalitis, 8 and our patient's clinical course was not consistent with infectious encephalitis and would not account for his recovery coinciding with treatment of hyperammonemia.…”

An exploration of the spectrum of peri-ictal MRI change; a comprehensive literature review

“…What has consistently been demonstrated over several studies is that the DWI changes identified in the peri-ictal period do not respect vascular neuroantatomical boundaries [19,54,92,109] which can be useful in identifying that the changes are ictal rather than vascular in origin.…”

“…Some points highlighted in the review have other practical clinical implications. Ictal related diffusion change on DWI does not respect vascular neuroanatomical boundaries [19,54,92,109]. These areas also demonstrate hyperperfusion on MRS or MRA which can be useful in identifying that the changes are ictal rather than ischaemic in origin in the emergent clinical setting.…”

“…It stands to reason that patients who display cortical diffusion restriction should have concordant EEG abnormalities [109]. The abnormalities described are broad and include PLEDs, focal slow wave activity (either delta or theta frequency) and focal spikes [20,32,77,110].…”

Reversible Cytotoxic Edema in a Cirrhotic Patient Following TIPS

“…Moreover, our patient made a substantial recovery over several days, which is in stark contrast to the dismal prognosis of patients with ischemic cortical laminar necrosis. Other conditions such as status epilepticus have been associated with findings of reversible cortical cytotoxic edema on brain MRI; however, in those reported cases the areas of involvement are distributed in a unilateral or asymmetric bilateral pattern, 6,7 which is in contrast to the symmetric distribution of findings in our patient. Meningoencephalitis caused by infectious pathologens such as herpesviruses have been shown to result in cortical cytotoxic edema; however, in our patient the findings were not limited to the limbic cortex as is most frequently reported in herpes encephalitis, 8 and our patient's clinical course was not consistent with infectious encephalitis and would not account for his recovery coinciding with treatment of hyperammonemia.…”

An exploration of the spectrum of peri-ictal MRI change; a comprehensive literature review

“…What has consistently been demonstrated over several studies is that the DWI changes identified in the peri-ictal period do not respect vascular neuroantatomical boundaries [19,54,92,109] which can be useful in identifying that the changes are ictal rather than vascular in origin.…”

“…Some points highlighted in the review have other practical clinical implications. Ictal related diffusion change on DWI does not respect vascular neuroanatomical boundaries [19,54,92,109]. These areas also demonstrate hyperperfusion on MRS or MRA which can be useful in identifying that the changes are ictal rather than ischaemic in origin in the emergent clinical setting.…”

“…It stands to reason that patients who display cortical diffusion restriction should have concordant EEG abnormalities [109]. The abnormalities described are broad and include PLEDs, focal slow wave activity (either delta or theta frequency) and focal spikes [20,32,77,110].…”