title: Pathology of bilateral pulvinar degeneration following long duration status epilepticus.
abstract: OBJECTIVE
  To define the neuropathological findings of pulvinar degeneration seen in long duration status epilepticus.
  
  
  METHODS
  We review the clinical, radiologic, neurophysiologic, investigational and neuropathological findings on a 27 year old woman who died after 162 days of prolonged refractory status epilepticus.
  
  
  RESULTS
  Continuous EEG monitoring confirmed recurrent uncontrolled seizure activity bilaterally and independently, most frequent in the right fronto-temporal region. Initial MRI of the brain was normal. Repeat study until on day 127 of admission showed advanced changes, with bilateral pulvinar T2/FLAIR hyperintensities. The autopsy revealed sharply defined, grey, soft, granular nodules in each medial pulvinar nucleus. Microscopically these consisted of sharply defined paucicellular areas with loss of neurons and myelin and with numerous macrophages in their centers, surrounded by reactive astrocytes with relatively spared of axons. The spinal cord at cervical and thoracic levels showed symmetric spongy vacuolation in the central part of the dorsal columns and lateral corticospinal tracts, with mild myelin loss, relatively preserved axons. The pathological lesions found in this case in thepulvinar are somewhat similar to the pathologic lesions described in Wernicke's encephalopathy. Those found in the spinal cord of our patient resemble characteristic features of B12 related subacute combined degeneration.
  
  
  CONCLUSIONS
  Characteristic pulvinar degeneration may be found as an acquired phenomenon in prolonged refractory status epilepticus. We hypothesize that the neuropathological findings result from an excessive focal metabolic demand, secondary to neuronal network over activation in the setting of prolonged, frequent bi-temporal seizures.
authors: Charles S Kubik Laboratory for Neuropathology, Department of Pathology, Boston, MA, USA; Servicio de Anatomía Patológica (Neuropatología) and Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: ahernandez.hdoc@salud.madrid.org.
authors: Aurelio
authors: A
authors: Hernandez-Lain
authors: E Tessa
authors: ET
authors: Hedley-Whyte
authors: Lida P
authors: LP
authors: Hariri
authors: Bradley
authors: B
authors: Molyneaux
authors: Keith J
authors: KJ
authors: Nagle
authors: Andrew J
authors: AJ
authors: Cole
authors: Ronan
authors: R
authors: Kilbride
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology*; D009474:Neurons / Q000473:pathology; D020649:Pulvinar / Q000473:pathology*; D013226:Status Epilepticus / Q000150:complications / Q000473:pathology*
keywords: Epilepsy monitoring; MRI; Medical/systemic disease; Spinal cord; Status epilepticus