Neurophysiological and neuroimaging changes (crossed cerebrocerebellar atrophy) after prolonged non-convulsive status epilepticus

Alterações de neuroimagem e de neurofisiologia após estado de mal epiléptico não-convulsivo

A 33-year-old female patient suffering from epilepsy since the age of seven years (Figure 1) presented with left-sided hemiparesis following non-convulsive status epilepticus (NCSE) (Figure 2). Neuroimaging showed a reduction in volume of the right cerebral hemisphere and left cerebellar hemisphere (Figure 3). EEG showed asymmetry with right hemispheric slowing (Figure 4).

Figure 1
Cranial computed tomography before the patient was admitted to hospital due to non-convulsive status epilepticus (January 2015).

Figure 2
Brain images (April 2015) after the patient was admitted to hospital.

Figure 3
Brain MRI after the patient was admitted to hospital for non-convulsive status epilepticus (June 2015)

Figure 4
EEG performed in May 2015 showing asymmetry due to slowing of the right brain hemisphere (a sequela of prolonged non-convulsive status epilepticus).

NCSE can have deleterious effects on the CNS because of neuronal death after 30 to 60 minutes of continuous convulsive activity¹,². Following an episode of NCSE, 10 to 50% of patients present with incapacitating neurological deficit³. Cranial MRI may show a persistent hyperintense lesion in T2- or diffusion-weighted images⁴,⁵.

References

• ¹
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• ²
  Chapman MG, Smith M, Hirsch NP. Status epilepticus. Anaesthesia. 2001;56(7):648-59. doi:10.1046/j.1365-2044.2001.02115.x
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  Cooper AD, Britton JW, Rabinstein AA. Functional and cognitive outcome in prolonged refractory status epilepticus. Arch Neurol. 2009;66(12):1505-9. doi:10.1001/archneurol.2009.273
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  Donaire A, Carreno M, Gómez B, Fossas P, Bargalló N, Agudo R et al. Cortical laminar necrosis related to prolonged focal status epilepticus. J Neurol Neurosurg Psychiatry. 2006;77(1):104-6. doi:10.1136/jnnp.2004.058701
• ⁵
  Parmar H, Lim SH, Tan NC, Lim CC. Acute symptomatic seizures and hippocampus damage: DWI and MRS findings. Neurology. 2006;66(11):1732-5. doi:10.1212/01.wnl.0000218207.18707.f4

Publication Dates

• Publication in this collection
  Mar 2016

History

• Received
  13 July 2015
• Received
  14 Aug 2015
• Accepted
  04 Sept 2015