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Images in Neurology • Arq. Neuro-Psiquiatr. 74 (3) • Mar 2016 • https://doi.org/10.1590/0004-282X20150214 linkcopy

Open-access 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

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

    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 Fountain NB, Lothman EW. Pathophysiology of status epilepticus. J Clin Neurophysiol. 1995;12(4):326-42.
    • 2 Chapman MG, Smith M, Hirsch NP. Status epilepticus. Anaesthesia. 2001;56(7):648-59. doi:10.1046/j.1365-2044.2001.02115.x
    • 3 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
    • 4 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
    Creative Common - by 4.0
    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.
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