title: Focal and Generalized Patterns of Cerebral Cortical Veins Due to Non-Convulsive Status Epilepticus or Prolonged Seizure Episode after Convulsive Status Epilepticus - A MRI Study Using Susceptibility Weighted Imaging.
abstract: OBJECTIVE
  The aim of this study was to investigate variant patterns of cortical venous oxygenation during status epilepticus (SE) using susceptibility-weighted imaging (SWI).
  
  
  METHODS
  We analyzed magnetic resonance imaging (MRI) scans of 26 patients with clinically witnessed prolonged seizures and/or EEG-confirmed SE. All MRI exams encompassed SWI, dynamic susceptibility contrast perfusion MRI (MRI-DSC) and diffusion-weighted imaging (DWI). We aimed to identify distinct patterns of SWI signal alterations that revealed regional or global increases of cerebral blood flow (CBF) and DWI restrictions. We hypothesized that SWI-related oxygenation patterns reflect ictal or postictal patterns that resemble SE or sequelae of seizures.
  
  
  RESULTS
  Sixteen patients were examined during nonconvulsive status epilepticus (NCSE) as confirmed by EEG, a further ten patients suffered from witnessed and prolonged seizure episode ahead of imaging without initial EEG. MRI patterns of 15 of the 26 patients revealed generalized hyperoxygenation by SWI in keeping with either global or multifocal cortical hyperperfusion. Eight patients revealed a focal hyperoxygenation pattern related to focal CBF increase and three patients showed a focal deoxygenation pattern related to focal CBF decrease.
  
  
  CONCLUSIONS
  SWI-related hyper- and deoxygenation patterns resemble ictal and postictal CBF changes within a range from globally increased to focally decreased perfusion. In all 26 patients the SWI patterns were in keeping with ictal hyperperfusion (hyperoxygenation patterns) or postictal hypoperfusion (deoxygenation patterns) respectively. A new finding of this study is that cortical venous patterns in SWI can be not only focally, but globally attenuated. SWI may thus be considered as an alternative contrast-free MR sequence to identify perfusion changes related to ictal or postictal conditions.
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.|Institute of Radiology and Neuroradiology, Tiefenau Hospital, Bern, Switzerland.
authors.forename: Rajeev Kumar
authors.initials: RK
authors.lastname: Verma
authors.affiliation: Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Abela
authors.affiliation: Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Schindler
authors.affiliation: Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Heinz
authors.initials: H
authors.lastname: Krestel
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Springer
authors.affiliation: University Institute for Diagnostic and Interventional Radiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Huber
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Weisstanner
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Martinus
authors.initials: M
authors.lastname: Hauf
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping / Q000379:methods; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology*; D013226:Status Epilepticus / Q000175:diagnosis* / Q000503:physiopathology*; D055815:Young Adult