Reversible MRI abnormalities in mesial temporal lobe epilepsy: a case report

Chiara Pizzanelli, Lorenzo Caciagli, Veronica Bartolami, Filippo Sean Giorgi, Ilaria Pesaresi, Melania Guida, Ubaldo Bonuccelli

DOI: https://doi.org/10.7175/cmi.v7i3.880

Abstract

The question regarding  the existence of abnormalities in the neuroimaging exams immediately after status epilecticus or epileptic seizures, but showing complete reversibility after a proper antiepileptic therapy, has long been debated. The first reports attempting to demonstrate their existence date back to the 1980s, and relied upon computed tomography as the imaging method of choice. After the introduction of MRI, a more appropriate characterization of these abnormalities was obtained along with the description of their most frequent features: (a) T2 signal hyperintensity in the white matter and, occasionally, (b) reduced apparent diffusion coefficient (ADC) and increased signal in DWI sequences.

The MRI abnormalities induced by epileptic activity pose a broad differential diagnosis including infections, inflammatory autoimmune encephalopathies, neoplasms. It remains a diagnosis of exclusion and requires proper diagnostic iter in order to reduce the risk of misdiagnosis and unnecessary intervention.

In this case report, a thorough presentation will be outlined about MRI alterations in the left mesial temporal lobe, which resulted completely reversible after a proper antiepileptic therapy.

Keywords

Epilepsy; MRI; Reversible abnormalities; Seizures

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References

  • Cianfoni A, Caulo M, Cerase A et al. Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol 2013; 82: 1964-72; http://dx.doi.org/10.1016/j.ejrad.2013.05.020
  • Sethi PK, Kumar BR, Madan VS et al. Appearing and disappearing CT scan abnormalities and seizures. J Neurol Neurosurg Psychiatry 1985; 48: 866-9; http://dx.doi.org/10.1136/jnnp.48.9.866
  • Goulatia RK, Verma A, Mishra NK et al. Disappearing CT lesions in epilepsy. Epilepsia 1987; 28: 523-7; http://dx.doi.org/10.1111/j.1528-1157.1987.tb03682.x
  • Dillon W, Brant-Zawadzki M, Sherry RG. Transient computed tomographic abnormalities after focal seizures. AJNR Am J Neuroradiol 1984; 5: 107-9
  • Henry TR, Drury I, Brunberg JA et al. Focal cerebral magnetic resonance changes associated with partial status epilepticus. Epilepsia 1994; 35: 35-41; http://dx.doi.org/10.1111/j.1528-1157.1994.tb02909.x
  • Cole AJ. Status epilepticus and periictal imaging. Epilepsia 2004; 45 S4: 72-7; http://dx.doi.org/10.1111/j.0013-9580.2004.04014.x
  • Szabo K, Poepel A, Pohlmann-Eden B et al. Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain 2005; 128: 1369-76; http://dx.doi.org/10.1093/brain/awh454
  • Holmes GL. Seizure-induced neuronal injury: animal data. Neurology 2002; 59 S3-6; http://dx.doi.org/10.1212/WNL.59.9_suppl_5.S3
  • Beghi E, De Maria G, Gobbi G et al. Diagnosis and treatment of the first epileptic seizure: Guidelines of the Italian League Agaist Epilepsy. Epilepsia 2006; 47 (Suppl 5): 2-8; http://dx.doi.org/10.1111/j.1528-1167.2006.00869.x
  • Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 2005; 76 (S2): 2-7
  • Gultekin Humayun S, Rosenfeld MR, Voltz R et al. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 2000; 123: 1481-94; http://dx.doi.org/10.1093/brain/123.7.1481
  • Glauser T, Ben-Menachem E, Bourgeois B et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54 (3): 551-63; http://dx.doi.org/10.1111/epi.12074

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