title: Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI).
abstract: OBJECTIVE
  To investigate pathological findings in the susceptibility weighted imaging (SWI) of patients experiencing convulsive (CSE) or non-convulsive status epilepticus (NCSE) with focal hyperperfusion in the acute setting.
  
  
  METHODS
  Twelve patients (six with NCSE confirmed by electroencephalogram (EEG) and six patients with CSE with seizure event clinically diagnosed) underwent MRI in this acute setting (mean time between onset of symptoms and MRI was 3 h 8 min), including SWI, dynamic susceptibility contrast MR imaging (DSC) and diffusion-weighted imaging (DWI). MRI sequences were retrospectively evaluated and compared with EEG findings (10/12 patients), and clinical symptoms.
  
  
  RESULTS
  Twelve out of 12 (100 %) patients showed a focal parenchymal area with pseudo-narrowed cortical veins on SWI, associated with focal hyperperfused areas (increased cerebral blood flow (CBF) and mean transit time (MTT) shortening), and cortical DWI restriction in 6/12 patients (50 %). Additionally, these areas were associated with ictal or postical EEG patterns in 8/10 patients (80 %). Most frequent acute clinical findings were aphasia and/or hemiparesis in eight patients, and all of them showed pseudo-narrowed veins in those parenchymal areas responsible for these symptoms.
  
  
  CONCLUSIONS
  In this study series with CSE and NCSE patients, SWI showed focally pseudo-narrowed cortical veins in hyperperfused and ictal parenchymal areas. Therefore, SWI might have the potential to identify an ictal region in CSE/NCSE.
  
  
  CONCLUSIONS
  • The focal ictal brain regions show hyperperfusion in DSC MR-perfusion imaging. • SWI shows focally diminished cortical veins in hyperperfused ictal regions. • SWI has the potential to identify a focal ictal region in CSE/NCSE.
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
authors.forename: Jerome
authors.initials: J
authors.lastname: Aellen
authors.forename: Eugenio
authors.initials: E
authors.lastname: Abela
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Buerki
authors.forename: Raimund
authors.initials: R
authors.lastname: Kottke
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Springer
authors.forename: Kaspar
authors.initials: K
authors.lastname: Schindler
authors.forename: Christian
authors.initials: C
authors.lastname: Weisstanner
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000503:physiopathology*; D055815:Young Adult
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