1 / 19

MRI Changes In Status Epilepticus: A Systematic Review In A Tertiary Center.

MRI Changes In Status Epilepticus: A Systematic Review In A Tertiary Center. Núria Bargalló, Teresa Lema,Mar Carreño, Antonio Donaire, Javier Aparicio, Iratxe Maestro. Hospital Clínic i Provincial de Barcelona. Background.

gillian
Download Presentation

MRI Changes In Status Epilepticus: A Systematic Review In A Tertiary Center.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. MRI Changes In Status Epilepticus: A Systematic Review In A Tertiary Center. Núria Bargalló, Teresa Lema,Mar Carreño, Antonio Donaire, Javier Aparicio, Iratxe Maestro. Hospital Clínic i Provincial de Barcelona

  2. Background • MRI changes due to status epilepticus (SE) often suggest a combination of cytotoxic and vasogenic edema, but it is unclear why only certain patients have MRI changes. • There are numerous case reports in the literature about these status-associated MRI signal changes; however, more extensive series on this subject are rare.

  3. Objectives • To study the frequency of MRI changes associated to episodes of status epilepticus (SE) . • To establish associations with different clinical and imaging features including the location of the epileptogencic zone. • To describe the most common MRI findings

  4. Methods. • We retrospectively reviewed the charts of 112 adult patients who were discharged from Hospital Clínic, Barcelona, with the diagnosis of Status Epilepticus (SE) from 2000 until 2010. • Subjects included: 27 patients who had MRI performed during the admission • Clinical and demographical data were examined, including: sex, age, previous history of epilepsy, type and etiology of SE and time between onset of SE and MR performance.

  5. MRI acquisition • MR examination: 1.5 T scan ( GE and Siemens) . • Sequences: T1WI, T2WI, FLAIR in all patients • DWI : n=24/27 • T1WI post gadolinium: n= 12/27 • Spectroscopy = 4/27 • All MRI data were reviewed by a neuroradiologist with expertise in epilepsy.

  6. Results. Clinical and demographic • 14 males and 13 females. • Mean age : 52 years ( range 20-88). • 17/27 ( 63%) No previous diagnosis of epilepsy • 10/27 (37%) have previous diagnosis of epilepsy. • 6/10 with low AED or AED withdrawal. • 4/10 for other provoking factors including sleep deprivation or febrile systemic disease . *mean time between SE and MRI exam: 5,11 days ( range 0-17 days)

  7. Types of status • 13/27 Complex partial status epilepticus. • 7/27. Simple motor focal SE, evolving to generalized convulsive in 4 patients. • 7/27 Generalized compulsive status epilepticus

  8. MRI findings • Changes related to SE: n=14; (51,8%) ( 3 also have epileptogenic lesion associated ) • Epileptogenic lesion: n=7; ( 25,9%).(Tumor, cysticercosis, ischemic injury) • MRI normal, n=9;( 33,3%) • No correlation between MRI changes and time of MRI exam, etiology of status. • Correlation between MRI changes and EEG findings( p<0.05).

  9. MRI changes related to SE ( n=14) • Diffuse involvement: 8/14 p. (57,14%) • Focal involvement : 6/14 p. ( 42,8%) • Limbic system: 9/14 (64%) • neocortex: 7 /14 p (50%) • neocortex and subcortical structures: =3/14 (21,4%) • neocortex, subcortical white matter and basal ganglia-thalamus: 3/14 (21,4%). • + cerebellum : 1/ 14p.(7,1%) • There is a tend between focal involvement and previous epilepsy p =0,06. • Anoxia ( 3p) and infections (2 p) shows diffuse lesions.

  10. MRI Characteristics: • Diffuse pattern. (8): - T2WI 7/8 and FLAIR 8/8 - DWI 5/8 - ADC 3/8; ADC 2/8; normal 3/8. - Gyral enhancement 0/5. • Focal pattern. (6) : - T2WI 6/6 and FLAIR 6/6 - DWI 5/5 - ADC 3/5; ADC 2/5. - Gyral enhancement 4/5. - MRS lactate 2/2 * Mean time between SE and MRI exam : ADC = 3,78 days ; ADC = 5,25 days; normal ADC = 3,33 days

  11. Focalinvolvement CPSE. Time 3 days. EEG: Right hemispheric spikes and slow wave discharge. Previous diagnosis of epilepsy . Brain trauma with right malacic changes.

  12. Diffuseinvolvement CPSE. Time 3 days. EEG: right posterior sharp waves and slow waves, continuous left hemispheric slow waves, BIPLEDs. No previous diagnosis of epilepsy .

  13. Focalinvolvement CPSE. Time 8 days. EEG: Left frontal-temporal seizures. Intercritical PLEDS. Previous diagnosis of epilepsy ,low AED.

  14. Focal Involvement. CPSE. Time 8 days. EEG: Left frontal-temporal seizures. Intercritical PLEDS. Previous diagnosis of epilepsy ,low AED.

  15. Diffuse Involvement. CPSE. Time 4 days. EEG: PLEDS. subclinical seizures. No previous diagnosis of epilepsy. Anoxia

  16. Focal Involvement. CPSE. Time 1 day. EEG: Right parietal-occipital continuous spikes. . No previous diagnosis of epilepsy.

  17. Diffuse Involvement. Focal SE secondarily generalized. Time 1 day. EEG: Right fronto-temporal continuous spikes. . No previous diagnosis of epilepsy. Liver transplant

  18. Varicela-zoster encephalopathy

  19. Conclusion • MRI changes in status epilepticus can be observed in about 50% of patients. • Two imaging patterns can be observed: focal or diffuse involvement and in some cases seems to be related with etiology. • Cortical signal abnormalities in T2WI, FLAIR and DWI are the most frequently observed. • Findings related to intra or extracelular edema can be observed in SE

More Related