Valproate-induced encephalopathy: assessment with MR imaging and 1H MR spectroscopy.
The anticonvulsant agent valproate (VPA) may cause hyperammonemic encephalopathy. Magnetic resonance imaging (MRI) and proton MR spectroscopic (MRS) findings in a patient with VPA-induced hyperammonemic encephalopathy are described. MRI showed a metabolic-toxic lesion pattern with bilateral T2-hyperintense lesions in the cerebellar white matter and in the globus pallidus. MR spectroscopic findings were indistinguishable from hepatic encephalopathy with severe depletion of myoinositol and choline and with glutamine excess. N-Acetylaspartate levels were moderately decreased. Quantitative MRS gave detailed insight into alterations of brain metabolism in VPA-induced encephalopathy.
Section of Neuroradiology, Department of Neurosurgery, and Section of Medical Physics, Department of Diagnostic Radiology, University Hospital, Freiburg, Germany. ziyeh@nz.ukl.uni-freiburg.de
Sargon
S
Ziyeh
Thorsten
T
Thiel
Joachim
J
Spreer
Joachim
J
Klisch
Martin
M
Schumacher
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D001928:Brain Diseases, Metabolic / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism*; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D004827:Epilepsy / Q000188:drug therapy / Q000378:metabolism; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism*; D007294:Inositol / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D009778:Occipital Lobe / Q000378:metabolism; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
D000927:Anticonvulsants; D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; D007294:Inositol; D014635:Valproic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline