title: Seizure-induced MRI changes mimicking metastatic brain disease.
abstract: Non-convulsive status epilepticus (NCSE) can present with heterogeneous clinical manifestations including prolonged confusion. MRI of the brain may demonstrate enhancing signal abnormalities that can mimic various pathologies including disease progression in patients with brain tumour. These neuroimaging changes are usually reversible and have been attributed to a combination of cytotoxic and vasogenic oedema. We report an interesting patient with a past history of prostatic rhabdomyosarcoma and brain metastasis presenting with NCSE where brain MRI demonstrated marked left hemispheric signal abnormalities, raising concerns about tumour recurrence. However the neuroimaging changes resolved following treatment with intravenous anticonvulsants, confirming that they were an effect rather than the cause of seizures. Recognition of seizure-related imaging abnormalities is important to institute prompt appropriate treatment, and to avoid diagnostic ambiguity and unnecessary treatment and/or investigations.
authors.affiliation: Department of Neurology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, PR2 9HT, UK. Electronic address: chhetri@doctors.org.uk.
authors.forename: Suresh Kumar
authors.initials: SK
authors.lastname: Chhetri
authors.affiliation: Department of Neuroradiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Sachin
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Neuroradiology, Greater Manchester Neurosciences Centre, Salford Royal Hospital, Manchester, UK.
authors.forename: Calvin
authors.initials: C
authors.lastname: Soh
authors.affiliation: Department of Neurology, Greater Manchester Neurosciences Centre, Salford Royal Hospital, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Gosal
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis*; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology; D013226:Status Epilepticus / Q000175:diagnosis* / Q000209:etiology
keywords: Non-convulsive status epilepticus; Seizure induced reversible signal changes; Tumour