Putaminal involvement in Rasmussen encephalitis.
BACKGROUND
Rasmussen encephalitis (RE) is a rare devastating disease of childhood causing progressive neurological deficits and intractable seizures, typically affecting one hemisphere. Characteristic MRI features include progressive unihemispheric focal cortical atrophy and grey- or white-matter high-signal changes and basal ganglion involvement, particularly of the caudate nucleus.


OBJECTIVE
To analyse the pattern of involvement of different brain structures in a series of patients with RE and to attempt clinical correlation.


METHODS
We reviewed the medical records and neuroimaging data of 12 patients diagnosed with RE satisfying the European Consensus Statement diagnostic criteria.


RESULTS
The disease manifested as seizures in all patients and was refractory; epilepsia partialis continua was a notable feature (nine patients). Hemiparesis of varying grades was noted in all but one patient; none had extrapyramidal signs. Neuroimaging showed cortical involvement in the insular/periinsular regions in 11 patients. Caudate atrophy was noted in ten patients. Putaminal atrophy was seen in nine patients, six of whom had additional hyperintense signal changes.


CONCLUSIONS
Our study highlights frequent putaminal atrophy and signal changes in RE, which suggests a more extensive basal ganglion involvement than emphasized previously. Recognition of putaminal changes may be a useful additional tool in the radiological diagnosis of RE.
Rajesh
Bhagavatheeswaran
B
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Kesavadas
Chandrasekharan
C
Ashalatha
Radhakrishnan
R
Thomas
Bejoy
B
D002648:Child; D003337:Corpus Callosum / Q000601:surgery*; D018450:Disease Progression; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004827:Epilepsy / Q000209:etiology* / Q000601:surgery; D005260:Female; D038421:Hemispherectomy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011699:Putamen / Q000473:pathology*