Congruence of the topography of intracranial calcifications and epileptic foci

Cukiert, A.; Puglia, P.; Scapolan, H.B.; Vilela, M.M.; Marino Jr, R.

doi:10.1590/S0004-282X1994000300001

Abstracts

Nodular intracranial calcifications (NIC) are frequent findings in CT scans of epileptic patients in countries where granulomatous central nervous disease such as neurocysticercosis is endemic. In 34 consecutive epileptic patients with NIC submitted teo EEG, CT and CSF analysis, the correlation between the electroclinical localization of the focus and the topography of the NIC was studied. Twenty-nine patients had partial (Group I) and 5 had primarily generalized seizures (Group II). Twenty group I and 1 group II patients showed abnormal EEGs. CSF abnormalities consisted of increased protein content (n=3) and positive Weinberg's reaction (n=2). In 2 cases, viable neurocysticercotic vesicles were seen. Twenty-one patients had single NICs. No correlation could be stablished in group II patients. Within group 1,15 patients had a positive and 14 a negative correlation. Sixty-six percent of the patients with single NICs had negative correlations. These findings strongly suggest that the calcifications themselves are not the epileptogenic lesions in at least 50% of the studied cases.

epilepsy; calcifications; CT; EEG

Calcificações nodulares intracranianas (CIN) representam achado frequente em pacientes epilépticos de países onde doenças granulomatosas do SNC (p.e.: neurocisticercose) são endêmicas. Trinta e quatro pacientes epilépticos consecutivos com CINs foram submetidos a exame de EEG, TC e LCR. A correlação entre a topografia do foco e das calcificações foi estudada em cada caso. Vinte e nove pacientes tinham crises parciais (Grupo I) e 5 crises primariamente generalizadas (Grupo II). Vinte pacientes do Grupo I e 1 do grupo II tinham EEGs anormais. Hiperproteinorraquia (n=3) e reação de Weinberg positiva foram as alterações encontradas no LCR. Em 2 casos, vesículas neurocisticercóticas íntegras foram vistas na tomografia. Vinte e um pacientes possuíam CIN única. Não foi possível realizar a correlação clínica nos pacientes do Grupo II. No grupo I, 15 pacientes apresentaram correlação positiva e 14 negativa. Sessenta e quatro por cento dos pacientes com calcificação única apresentaram correlação negativa. Estes achados sugerem fortemente que as calcificações não são epileptogênicas em ao menos 50% dos casos estudados.

epilepsia; calcificações; TC; EEG

Congruence of the topography of intracranial calcifications and epileptic foci

Congruência da topografía de calcificações intracranianas e focos epilépticos

A. Cukiert; P. Puglia; H.B. Scapolan; M.M. Vilela; R. Marino Jr.

Departament of Neurology and Neurosurgery University of São Paulo School of Medicine

SUMMARY

Nodular intracranial calcifications (NIC) are frequent findings in CT scans of epileptic patients in countries where granulomatous central nervous disease such as neurocysticercosis is endemic. In 34 consecutive epileptic patients with NIC submitted teo EEG, CT and CSF analysis, the correlation between the electroclinical localization of the focus and the topography of the NIC was studied. Twenty-nine patients had partial (Group I) and 5 had primarily generalized seizures (Group II). Twenty group I and 1 group II patients showed abnormal EEGs. CSF abnormalities consisted of increased protein content (n=3) and positive Weinberg's reaction (n=2). In 2 cases, viable neurocysticercotic vesicles were seen. Twenty-one patients had single NICs. No correlation could be stablished in group II patients. Within group 1,15 patients had a positive and 14 a negative correlation. Sixty-six percent of the patients with single NICs had negative correlations. These findings strongly suggest that the calcifications themselves are not the epileptogenic lesions in at least 50% of the studied cases.

Key words: epilepsy, calcifications, CT, EEG.

RESUMO

Calcificações nodulares intracranianas (CIN) representam achado frequente em pacientes epilépticos de países onde doenças granulomatosas do SNC (p.e.: neurocisticercose) são endêmicas. Trinta e quatro pacientes epilépticos consecutivos com CINs foram submetidos a exame de EEG, TC e LCR. A correlação entre a topografia do foco e das calcificações foi estudada em cada caso. Vinte e nove pacientes tinham crises parciais (Grupo I) e 5 crises primariamente generalizadas (Grupo II). Vinte pacientes do Grupo I e 1 do grupo II tinham EEGs anormais. Hiperproteinorraquia (n=3) e reação de Weinberg positiva foram as alterações encontradas no LCR. Em 2 casos, vesículas neurocisticercóticas íntegras foram vistas na tomografia. Vinte e um pacientes possuíam CIN única. Não foi possível realizar a correlação clínica nos pacientes do Grupo II. No grupo I, 15 pacientes apresentaram correlação positiva e 14 negativa. Sessenta e quatro por cento dos pacientes com calcificação única apresentaram correlação negativa. Estes achados sugerem fortemente que as calcificações não são epileptogênicas em ao menos 50% dos casos estudados.

Palavras-chave: epilepsia, calcificações, TC, EEG.

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Aceite: 3-março-1994.

Dr. Arthur Cukiert - Rua Baltazar Veiga, 367/151 - 04510-001 São Paulo SP - Brasil.

1. Adams C, Hwang PA, Gilday DL, Armstrong DC, Becker LE and Hoffmann HJ. Comparison of SPECT, EEG, CT, MRI and pathology in partial epilepsy. Pediatr Neurol 1992, 8: 97-103.
2. Bauer G, Mayr U and Pallua A. Computerized axial tomography in chronic partial epilepsies. Epilepsia 1980, 21: 227-233.
3. Daras M, Tuchman AJ, Strobos RJ. Computed tomography in adult onset epileptic seizures in a city hospital population. Epilepsia 1987, 28: 519-522.
4. Del Brutto OH, Santibanez R, Noboa CA, Aguirre R, Diaz E, Alarcon TA. Epilepsy due to neurocysticercosis. Neurology 1992, 42: 389-392.
5. Gastaut H. Conclusions computerized transverse axial tomography in epilepsy. Epilepsia 1976, 17: 337-338.
6. Gastaut H, Gastaut JL. Computerized transverse axial tomography in epilepsy. Epilepsia 1976, 17: 325-336.
7. Heinz ER, Heinz TR, Radtke R, Darwin R, Drayer BP, Fram E, Djang WT. Efficacy of MR vs CT in epilepsy. Am J Radiol 1989, 152: 347-352.
8. Holland BA, Kucharcyzk W, Brant-Zawadzky M, Norman D, Hass DK, Harper PS. MR imaging of calcified intracranial lesions. Radiology 1985, 157: 353-356.
9. Kendall B, Cavanagh N. Intracranial calcification in pediatric computed tomography. Neuroradiology 1986, 28: 324-330.
10. Medina MT, Rosas E, Rubio-Donadieu F, Sotelo J. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 1990, 150: 325-327.
11. Mervis B,. Lotz JW. Computed tomography in parenchimatous cerebral cysticercosis. Clin Radiol 1980, 31: 521-528.
12. Ogata A, Ishida S, Wada TA. A survey of 37 cases with basal ganglia calcification: CT scan findings and its relationship to underlying diseases and epilepsy. Acta Neurol Scand 1987, 75: 117-124.
13. Shomer W, Meencke HJ, Felix R. Temporal lobe epilepsy: comparison of CT and MR imaging. Am J Radiol 1987, 149: 1231-1239.
14. Sotelo J, Guerrero V, Rubio F. Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases. Arch Intern Med 1985, 145: 442-445.
15. Spina-Franca. A. Cisticercose do SNC. Considerações acerca de 50 casos. Rev Paulista Med 1956,48: 59-70.
16. Spina-Franca A, Livramento JA. CSF immunology in neurocysticercosis. Eur Rev Med Pharm Sci 1982, 4: 385-388.
17. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M,. Khonsari A. Neuroimaging in temporal lobe epilepsy: test sensitivity and relationships to pathology and post-operative outcome. Epilepsia 1992, 33: 624-634.
18. Theodore WH, Dorwart R, Holmes M, Porter RJ, Di Chiro G. Neuroimaging in refractory partial seizures. Comparison of PET, CT and MRI. Neurology 1986, 36: 750-759.
19. Vakaet A, Rubens R, Reuck J, Eecken H. Intracranial bilateral symmetrical calcification on CT-scanning. Clin Neurol Neurosurg 1985, 87: 103-111.
20. Weisinger JR, Mongollon A, Lander R, Bellorin-Font E, Riera R, Abadi I, Paz-Martinez V. Massive cerebral calcifications associated with increased renal phosphate reabsorption. Arch Intern Med 1986, 146: 473-477.
21. Yaqub BA, Panayaiotopoulos C, Al-Nozha M, Qteishat W, Al-Dalaan A. Causes of late onset epilepsy in Saudi Arabia: the role of cerebral granuloma. J Neurol Neurosurg Psychiatry 1987, 50: 90-92.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Sept 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams C, Hwang PA, Gilday DL, Armstrong DC, Becker LE and Hoffmann HJ. Comparison of SPECT, EEG, CT, MRI and pathology in partial epilepsy. Pediatr Neurol 1992, 8: 97-103.

[2] 2. Bauer G, Mayr U and Pallua A. Computerized axial tomography in chronic partial epilepsies. Epilepsia 1980, 21: 227-233.

[3] 3. Daras M, Tuchman AJ, Strobos RJ. Computed tomography in adult onset epileptic seizures in a city hospital population. Epilepsia 1987, 28: 519-522.

[4] 4. Del Brutto OH, Santibanez R, Noboa CA, Aguirre R, Diaz E, Alarcon TA. Epilepsy due to neurocysticercosis. Neurology 1992, 42: 389-392.

[5] 5. Gastaut H. Conclusions computerized transverse axial tomography in epilepsy. Epilepsia 1976, 17: 337-338.

[6] 6. Gastaut H, Gastaut JL. Computerized transverse axial tomography in epilepsy. Epilepsia 1976, 17: 325-336.

[7] 7. Heinz ER, Heinz TR, Radtke R, Darwin R, Drayer BP, Fram E, Djang WT. Efficacy of MR vs CT in epilepsy. Am J Radiol 1989, 152: 347-352.

[8] 8. Holland BA, Kucharcyzk W, Brant-Zawadzky M, Norman D, Hass DK, Harper PS. MR imaging of calcified intracranial lesions. Radiology 1985, 157: 353-356.

[9] 9. Kendall B, Cavanagh N. Intracranial calcification in pediatric computed tomography. Neuroradiology 1986, 28: 324-330.

[10] 10. Medina MT, Rosas E, Rubio-Donadieu F, Sotelo J. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 1990, 150: 325-327.

[11] 11. Mervis B,. Lotz JW. Computed tomography in parenchimatous cerebral cysticercosis. Clin Radiol 1980, 31: 521-528.

[12] 12. Ogata A, Ishida S, Wada TA. A survey of 37 cases with basal ganglia calcification: CT scan findings and its relationship to underlying diseases and epilepsy. Acta Neurol Scand 1987, 75: 117-124.

[13] 13. Shomer W, Meencke HJ, Felix R. Temporal lobe epilepsy: comparison of CT and MR imaging. Am J Radiol 1987, 149: 1231-1239.

[14] 14. Sotelo J, Guerrero V, Rubio F. Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases. Arch Intern Med 1985, 145: 442-445.

[15] 15. Spina-Franca. A. Cisticercose do SNC. Considerações acerca de 50 casos. Rev Paulista Med 1956,48: 59-70.

[16] 16. Spina-Franca A, Livramento JA. CSF immunology in neurocysticercosis. Eur Rev Med Pharm Sci 1982, 4: 385-388.

[17] 17. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M,. Khonsari A. Neuroimaging in temporal lobe epilepsy: test sensitivity and relationships to pathology and post-operative outcome. Epilepsia 1992, 33: 624-634.

[18] 18. Theodore WH, Dorwart R, Holmes M, Porter RJ, Di Chiro G. Neuroimaging in refractory partial seizures. Comparison of PET, CT and MRI. Neurology 1986, 36: 750-759.

[19] 19. Vakaet A, Rubens R, Reuck J, Eecken H. Intracranial bilateral symmetrical calcification on CT-scanning. Clin Neurol Neurosurg 1985, 87: 103-111.

[20] 20. Weisinger JR, Mongollon A, Lander R, Bellorin-Font E, Riera R, Abadi I, Paz-Martinez V. Massive cerebral calcifications associated with increased renal phosphate reabsorption. Arch Intern Med 1986, 146: 473-477.

[21] 21. Yaqub BA, Panayaiotopoulos C, Al-Nozha M, Qteishat W, Al-Dalaan A. Causes of late onset epilepsy in Saudi Arabia: the role of cerebral granuloma. J Neurol Neurosurg Psychiatry 1987, 50: 90-92.