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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.

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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
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.
objectives
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
methods
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.
mri acquisition
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.
results clinical and demographic
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)

types of status
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
mri findings
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).
mri changes related to se n 14
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.
mri characteristics
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

slide11

Focalinvolvement

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

slide12

Diffuseinvolvement

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

slide13

Focalinvolvement

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

slide14

Focal Involvement.

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

slide15

Diffuse Involvement.

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

slide16

Focal Involvement.

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

slide17

Diffuse Involvement.

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

conclusion
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