Seizure-induced brain lesions: A wide spectrum of variably reversible MRI abnormalities
Seizure-induced brain lesions: A wide spectrum of variably reversible MRI abnormalities
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DOI：
10.1016/j.ejrad.2013.05.020
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发表时间：
2013-11-01
影响因子：
3.3
通讯作者：
Colosimo, C.
中科院分区：
文献类型：
--
作者：
Cianfoni, A.;Caulo, M.;Colosimo, C.
介绍MRI异常在posttotal期间可能代表的癫痫发作活动的影响，而不是其结构cause.Material和方法的临床和神经影像学图表的26例诊断为癫痫相关的MR信号变化的回顾性审查。所有患者均在癫痫发作后7天内接受脑MRI（1.5特斯拉，标准对比前后脑成像，包括19/26例患者的DWI-ADC），并至少进行一次随访MRI，显示MR信号变化的部分或完全可逆性。广泛的临床工作和随访，从3个月到5年不等，排除了感染或其他可能的脑损伤原因。癫痫引起的脑MRI异常仍然是排除诊断。结果MRI显示单侧（13/26）和双侧异常，T2信号高（24/26）和低（2/26），软脑膜对比增强（2/26），扩散受限（9/19）。异常部位为皮质/皮质下、基底节、白色物质、胼胝体、小脑。26例患者中10例累及海马。15例MRI改变完全可逆，11例伴有残留胶质增生或局灶性萎缩。在15至150天（平均62天）之间观察到可逆性。部分性简单发作和复杂发作与海马受累相关（p = 0.015），癫痫持续状态与MRI异常不完全可逆相关（p = 0.041）。部分性癫痫发作常伴有海马受累和癫痫持续状态伴不完全可逆性损害。这些脑损伤引起的MRI异常提出了广泛的鉴别诊断;提高认识可能会降低误诊和不必要干预的风险。(C)由Elsevier爱尔兰有限公司出版。
Introduction MRI abnormalities in the postictal period might represent the effect of the seizure activity, rather than its structural cause.Material and Methods Retrospective review of clinical and neuroimaging charts of 26 patients diagnosed with seizure-related MR-signal changes. All patients underwent brain-MRI (1.5-Tesla, standard pre- and post-contrast brain imaging, including DWI-ADC in 19/26) within 7 days from a seizure and at least one follow-up MRI, showing partial or complete reversibility of the MR-signal changes. Extensive clinical work-up and follow-up, ranging from 3 months to 5 years, ruled out infection or other possible causes of brain damage. Seizure-induced brain-MRI abnormalities remained a diagnosis of exclusion. Site, characteristics and reversibility of MRI changes, and association with characteristics of seizures were determined.Results MRI showed unilateral (13/26) and bilateral abnormalities, with high (24/26) and low (2/26) T2-signal, leptomeningeal contrast-enhancement (2/26), restricted diffusion (9/19). Location of abnormality was cortical/subcortical, basal ganglia, white matter, corpus callosum, cerebellum. Hippocampus was involved in 10/26 patients. Reversibility of MRI changes was complete in 15, and with residual gliosis or focal atrophy in 11 patients. Reversibility was noted between 15 and 150 days (average, 62 days). Partial simple and complex seizures were associated with hippocampal involvement (p = 0.015), status epilepticus with incomplete reversibility of MRI abnormalities (p = 0.041).Conclusions Seizure or epileptic status can induce transient, variably reversible MRI brain abnormalities. Partial seizures are frequently associated with hippocampal involvement and status epilepticus with incompletely reversible lesions. These seizure-induced MRI abnormalities pose a broad differential diagnosis; increased awareness may reduce the risk of misdiagnosis and unnecessary intervention. (C) 2013 Published by Elsevier Ireland Ltd.