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J Neurol Sci. 2014 Aug 15;343(1-2):167-72. doi: 10.1016/j.jns.2014.06.001. Epub 2014 Jun 11.

A wide spectrum of variably periictal MRI abnormalities induced by a single or a cluster of seizures.

Author information

1
Department of Neurology, First Affiliated Hospital of the University of South China, 69 Chuanshan Road, Hengyang, Hunan 421001, China. Electronic address: 327987649@qq.com.
2
Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China. Electronic address: tvtvtv06@163.com.
3
Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China.

Abstract

BACKGROUND:

Although predominantly reported in patients with status epilepticus, periictal MRI abnormalities have been reported in patients with a single or a cluster of seizures. Clinicians are often presented with a dilemma concerning the features of MRI abnormalities induced by a single or a cluster of seizures, as they may represent the effect of seizure activity rather than its structural cause.

METHODS:

A retrospective review of clinical and neuroimaging charts of 14 patients diagnosed with a single or a cluster of seizure-related MR-signal changes from the database of our unit (approximately 300 patients diagnosed with a single or a cluster of seizures underwent brain-MRI within 14 days from a seizure) was conducted. Extensive clinical work-up and follow-up, ranging from 3 months to 5 years, ruled out infection or other possible causes of brain damage. Site, characteristics and reversibility of MRI changes, and association with characteristics of seizures were determined.

RESULTS:

MRI showed unilateral abnormalities in 14 patients, with hyperintensities on T2-signal (12/14), fluid-attenuated inversion-recovery (FLAIR) (12/14), and restricted diffusion (6/8). Location of abnormality was cortical (4/14), subcortical (6/14), thalamus (2/14), corpus callosum (1/14), and bordering an old encephaloclastic lesion (1/14). Periictal MRI abnormalities and electroclinical findings in 10 patients showed an almost complete topographic concordance, which was not consistent in 4 patients. Reversibility of MRI changes was complete in 11 patients, partially disappeared in 1 patient, and irreversible on MRI in 2 patients.

CONCLUSIONS:

A single or a cluster of seizures cannot only induce transient, variably reversible MRI brain abnormalities, but also irreversible changes. These seizure-induced MRI abnormalities pose a broad differential diagnosis; increased awareness may reduce the risk of misdiagnosis and unnecessary intervention.

KEYWORDS:

Cluster of seizures; Differential diagnosis; MRI; Periictal MRI abnormalities; Seizure; Status epilepticus

PMID:
24950900
DOI:
10.1016/j.jns.2014.06.001
[Indexed for MEDLINE]

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