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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.10 São Paulo Oct. 2014

https://doi.org/10.1590/0004-282X20140132 

Images in Neurology

Postictal MRI features with a unilateral pattern

Alterações pós-ictais com distribuição unilateral na RM

Vanessa Dinoá

Felipe von Ranke

Emerson Gasparetto

Edson Marchiori

1Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.


A 14-year-old female presented with focal seizure and secondary generalized convulsive status epilepticus lasting 2 hours. Electroencephalography revealed diffuse slow waves. Magnetic resonance imaging performed 2 days after onset demonstrated cortical swelling, gyri effacement, and restricted diffusion affecting the right temporal and parietal lobes (Figure). The differential diagnosis of these abnormalities included infarction, ischemia, venous thrombosis, vasculitis, infection, neoplasm, and metabolic encephalopathy. Because imaging findings were resolved completely after 38 days without specific treatment aside from supportive seizure therapy, infarction, venous thrombosis, vasculitis, infection, and neoplasm became less likely. Seizure-induced transient cerebral swelling was the most probable diagnosis1,2,3.

Figure (A) Axial FLAIR and (B) coronal T2-weighted images show cortical swelling and gyri effacement in the right temporal and parietal lobes, with a mass effect over the right lateral ventricle; (C) DWI image shows restricted diffusion in this region; (D) Coronal T2-weighted images taken 38 days after onset show no initial feature or sequela. 

References

. Huang YC, Weng HH, Tsai YT, Huang YC, Hsiao MC, Wu CY et al. Periictal magnetic resonance imaging in status epilepticus. Epilepsy Res. 2009;86(1):72-81. http://dx.doi.org/10.1016/j.eplepsyres.2009.05.011 [ Links ]

. Rémi J, Vollmar C, Marinis A, Heinlin J, Peraud A, Noachtar S. Congruence and discrepancy of interictal and ictal EEG with MRI lesions in focal epilepsies. Neurology. 2011;77(14):1383-90. http://dx.doi.org/10.1212/WNL.0b013e31823152c3 [ Links ]

. Kim JA, Chung JI, Yoon PH, Kim DI, Chung TS, Kim EJ et al. Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001;22(6):1149-60. [ Links ]

Received: May 28, 2014; Revised: June 16, 2014; Accepted: July 04, 2014

Correspondence: Felipe von Ranke; Rua Joaquim Távora, 33/1203; 24230-541 Niterói RJ, Brasil; E-mail: feliperanke@yahoo.com.br

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.