Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus.
Diffusion-weighted imaging (DWI) has demonstrated a focal area of cytotoxic oedema during partial status epilepticus (PSE). However, vasogenic oedema related to the breakdown of the blood-brain-barrier (BBB) and ictal hyperperfusion could be the predominant DWI findings in the epileptogenic area during PSE. We report a case of PSE with ictal aphasia, right hemiparesis, and repetitive focal motor seizure of the right side. T2-weighted image (T2WI) and apparent diffusion coefficient (ADC) maps obtained during PSE showed an increased signal in the left temporo-parietal area, indicative of vasogenic oedema. EEG documented the ictal activities and single photon emission tomography (SPECT) showed asymmetrically increased perfusion in the corresponding area. Follow-up T2WI, DWI, and ADC maps obtained 3 months later showed the disappearance of the previous abnormalities. However, T2WI showed cortical atrophy and newly developed white matter changes in the corresponding area. This case shows that DWI findings may be variable during PSE, dependent on the predominance of cytotoxic and vasogenic oedema.
Hong
Keun-Sik
KS
Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsan-gu, Goyang-city, Gyonggi-do 411-706, South Korea. nrhks@ilsanpaik.ac.kr
Cho
Yong-Jin
YJ
Lee
Sang Kun
SK
Jeong
Sang-Wuk
SW
Kim
Won Kyoo
WK
Oh
Eun Jin
EJ
D000368:Aged; D001037:Aphasia / Q000209:etiology; D001921:Brain / Q000473:pathology; D001929:Brain Edema / Q000209:etiology*; D001931:Brain Mapping; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D013226:Status Epilepticus / Q000150:complications*; D015899:Tomography, Emission-Computed, Single-Photon