Periictal magnetic resonance imaging in status epilepticus.
OBJECTIVE
To determine the changes of magnetic resonance imaging (MRI) during the periictal phase in status epilepticus (SE).


METHODS
We identified 15 patients diagnosed of status epilepticus with corresponding MRI changes, including 11 patients with generalized convulsive status epilepticus (GCSE), 2 with complex partial status epilepticus (CPSE), and 2 with simple partial status epilepticus (SPSE). All MRI changes, corresponding electroencephalogram, and prognosis were evaluated.


RESULTS
Regional cortical lesions were observed on MRI, including restricted diffusion in diffusion-weighted images (DWIs) (11 out of 15) and hyperintense signal change in fluid-attenuated inversion recovery (FLAIR) images (12 out of 15) with hypervascularity and parenchymal swelling. The remote lesions included crossed cerebellar diaschisis (3 patients), ipsilateral thalamic lesion (4 patients), and basal ganglia lesions (3 patients). Although the periictal MRI changes were usually reversible, irreversible changes were also found, especially in GCSE, such as focal brain atrophy, cortical laminar necrosis, and mesial temporal sclerosis. GCSE patients with periodic epileptic form discharges had higher possibilities of widespread MRI abnormalities and poor prognosis in the future.


CONCLUSIONS
In this study, DWIs and FLAIR images were proved useful in determining the extent and severity of early neuronal damage caused by epileptic discharges in SE patients. Seizure-induced long-term injuries were also observed in the follow-up MRI.
Huang
Yen-Chu
YC
Department of Neurology, Chiayi Branch, Chang Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan.
Weng
Hsu-Huei
HH
Tsai
Yu-tai
YT
Huang
Ying-Chih
YC
Hsiao
Ming-Chang
MC
Wu
Chih-Ying
CY
Lin
Ya-Hui
YH
Hsu
Huan-Lin
HL
Lee
Jiann-Der
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis*; D013997:Time Factors; D055815:Young Adult