title: Cerebral hemiatrophy associated with hippocampal sclerosis following a single prolonged febrile seizure.
abstract: The etiological relation of prolonged febrile seizures with hippocampal sclerosis and cerebral hemiatrophy is controversial. Causal relationship is mainly adopted from retrospective statistical analysis and data from epilepsy surgery. We report a 17-month-old boy who had a prolonged febrile seizure with a transient postictal flaccid hemiparesis and anisocoria. Family history was unremarkable. Magnetic resonance imaging (MRI) revealed abnormal results in the right hippocampal area where diffusion-weighted sequences showed increased signal intensity consistent with acute neuronal edema. Repeat MRI 5 months later demonstrated sclerosis and atrophy of the right hippocampus in association with an increased T2-weighted signal and atrophy of the right frontal, temporal, and parietal lobe. In addition, 18-fluorodeoxyglucose positron emission tomography and 99mTc-ECD single-photon emission computed tomography revealed glucose hypometabolism and decreased perfusion in the right hemisphere, respectively. A final MRI, 12 months following the seizure, was widely unchanged. Interestingly, during a follow-up of 42 weeks, only minor motor deficits were observed. This case uniquely presents the acute onset of hippocampal sclerosis and, consecutively, cerebral hemiatrophy after a single febrile seizure. This suggests that a single prolonged febrile seizure may cause global morphological changes of the brain, not only affecting hippocampal formation.
authors.affiliation: Department of Neuropediatrics, Children's Hospital, University of Lübeck, Lübeck, Germany. orosz@paedia.ukl.mu-luebeck.de
authors.forename: Iren
authors.initials: I
authors.lastname: Orosz
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.forename: Stefan
authors.initials: S
authors.lastname: Gottschalk
authors.forename: Katharina
authors.initials: K
authors.lastname: von Hof
authors.forename: Christian G
authors.initials: CG
authors.lastname: Bien
authors.forename: Jürgen
authors.initials: J
authors.lastname: Sperner
mesh_terms: D001284:Atrophy / Q000209:etiology; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011859:Radiography; D012598:Sclerosis / Q000209:etiology; D003294:Seizures, Febrile / Q000150:complications*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon