Seizures and 'disappearing' brain lesions.
BACKGROUND--Patients with seizures may have abnormal brain imaging. Lesions demonstrated on computerized tomography or magnetic resonance imaging often suggest the underlying cause of the seizures, and may prompt an invasive investigation for diagnosis and treatment. In an increasingly recognized subset of patients however, the imaged lesions spontaneously resolve. While poorly understood, these 'disappearing' lesions may in fact be the consequence of seizures, rather than the cause. Two patients with 'disappearing' lesions are presented: the first patient had a proven cause, the second a probable one. Case 1. A patient with new onset seizures had an abnormal MRI. An angiogram confirmed thrombosis of the straight sinus. On follow-up, she was doing well; repeat imaging was normal with resolution of the lesion. Case 2. A patient with a long seizure history had been well controlled on medications, and had no change in frequency of her seizures. She was found to have a left homonymous hemianopsia. MRI revealed a right parieto-occipital lesion. The patient refused further work-up and was lost to follow-up. She returned almost a year later; repeat imaging was normal. CONCLUSION--Patients with seizures and abnormal imaging suggestive of structural lesions may occasionally have lesions that resolve spontaneously. While some diagnoses remain elusive, an important consideration to exclude in these patients is venous thrombosis.
Rao
T H
TH
Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA.
Libman
R B
RB
Patel
M
M
D000328:Adult; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis*; D001929:Brain Edema / Q000150:complications / Q000175:diagnosis; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D004678:Encephalomalacia / Q000150:complications / Q000175:diagnosis; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology*; D004829:Epilepsy, Generalized / Q000175:diagnosis / Q000209:etiology; D004834:Epilepsy, Post-Traumatic / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012075:Remission, Spontaneous; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed