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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.75 no.6 São Paulo June 2017

http://dx.doi.org/10.1590/0004-282x20170047 

IMAGES IN NEUROLOGY

Epilepsia partialis continua induces transient brain edema

Epilepsia parcial contínua induz edema cerebral transitório

Tiago Silva Aguiar1  2 

Gustavo Lopes de Freitas Honório1  2 

Samila Oliveira Silva1  2 

Renan Amaral Coutinho1  2 

Marcos Martins da Silva1  2 

Cláudia Cecília da Silva Rego1  2  2 

Marco Antônio Sales Dantas de Lima1  2 

Soniza Vieira Alves-Leon1  2  2 

1Universidade Federal do Rio de Janeiro, Faculdade de Medicina,

2Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;

2Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento Neurologia, Rio de Janeiro RJ, Brasil.

A 52-year-old woman with a past history of a tumefactive demyelinating lesion five years ago with left hemiparesis presented with a 30-day history of uninterrupted clonic movements involving her left face and upper limb, compatible with epilepsia partialis continua. An MRI showed right hemispheric cortical swelling (Figure 1). She received phenytoin, valproate and phenobarbital with control of the epilepsia partialis continua and resolution of the MRI abnormalities (Figure 2).

Figure 1 Brain MRI during epilepsia partialis continua. FLAIR (A) image: right hemispheric increased signal intensity and swelling at the cortical gray matter and subcortical white matter and mild midline shift. DWI (B) and ADC map (C): cortical hyperintensity and restricted diffusion. DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient 

Figure 2 Brain MRI two weeks after resolution of the epilepsia partialis continua with antiepileptic drugs. FLAIR (A) image: previous residual aspect of tumefactive demyelinating lesion with hyperintensities in periventricular and subcortical white matter. DWI (B) and ADC map (C) without restricted diffusion. DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient 

The reason for cerebral edema in status epilepticus is unknown1, but restricted cortical diffusion is consistent with cytotoxic edema by cellular energy failure2,3. It can be triggered by an imbalance between the energy supply and demand in neurons and it remains unclear why only certain patients have these abnormalities1,3,4.

References

1. Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016;38:63-7. https://doi.org/10.1016/j.seizure.2016.04.007Links ]

2. Hong KS, Cho YJ, Lee SK, Jeong SW, Kim WK, Oh EJ. Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure. 2004;13(5):317-21. https://doi.org/10.1016/j.seizure.2003.08.004Links ]

3. Chatzikonstantinou A, Gass A, Förster A, Hennerici MG, Szabo K. Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res. 2011;97(1-2):45-51. https://doi.org/10.1016/j.eplepsyres.2011.07.002Links ]

4. Cartagena AM, Young GB, Lee DH, Mirsattari SM. Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav. 2014;33:24-30. https://doi.org/10.1016/j.yebeh.2014.02.003Links ]

Suport: FAPERJ – Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro.

Received: August 25, 2016; Revised: February 04, 2017; Accepted: February 14, 2017

Correspondence: Soniza Vieira Alves-Leon; Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho/UFRJ; Rua Rodolpho Paulo Rocco, 255, Cidade Universitária; 21941-913 Rio de Janeiro RJ, Brasil; E-mail: sonizavleon@globo.com

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 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.