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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.2 São Paulo June 1994 

MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan


Achados de ressonância magnética e SPECT cerebral em pacientes com epilepsia unilateral do lobo temporal e com TC de crânio normal



P.G. Carrilho; E.M.T. Yacubian; A. Cukiert; L.A. Fiore; C.A. Buchpiguel; C.L. Jorge; H.B. Scapolan; L.A. Bacheschi; R. Marino Jr

Departments of Neurology and Radiology, School of Medicine, University of São Paulo, São Paulo SP - Brazil




26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n=16) and 65.4% of SPECT (n=17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n=12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n=13). There was also a good correlation between MRI and SPECT in 30.7% (n=8). SPECT and EEG were in agreement in 57.7% (n=l5). MRI, SPECT and EEG were congruent in 26.9% (n=7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

Key words: epilepsy, temporal lobe, CT, MRI, EEG, SPECT.


Foram estudados 26 pacientes com epilepsia do lobo temporal clinicamente documentada por vários EEGs com atividade epileptiforme intercrítica e TC de crânio normal. SPECT com99mTC HMPAO e ressonância magnética (RM) foram realizados em todos os casos. 61.5% (n=16) das RM e 65.4% (n=17) dos SPECTs revelaram algum tipo de anormalidade. Atrofia hipocampal, nas imagens enfatizadas em Tl e presença de hipersinal nas imagens enfatizadas em T2, sugerindo esclerose mesial temporal, foram o principal achado (n=12; 75% das RM anormais). RM correlacionou-se ao EEG em 50% (n=13). Concordância entre RM e SPECT ocorreu em 30.7% (n=8) e entre SPECTe EEG em 57.7% (n=15). RM, SPECT e EEG foram congruentes em 26.9% (n=7). Estes resultados refletem o valor do SPECT intercrítico e RM na detecção e lateralização de anormalidades em epilepsia do lobo temporal. Por outro lado, em dois casos, o SPECT correlacionou-se mal com o EEG. Este método funcional não deve ser utilizado isoladamente na detecção de focos temporais. RM é mais útil do que a TC como recurso de neuroimagem na epilepsia do lobo temporal. Ela pode detectar pequenas lesões estruturais e esclerose mesial temporal, não facilmente identificáveis pela TC.

Palavras-chave: epilepsia, lobo temporal, TC, RM, EEG, SPECT.



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Aceite: 4-outubro-1993.



Dr. Arthur Cukiert - Rua Baltazar da Veiga 367 apto 151 - 04510-001 São Paulo SP, Brasil. FAX (55.11) 533-7880.

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