Postictal MRI signal changes

Case contributed by Dr Dalia Ibrahim

Presentation

Seizures.

Patient Data

Age: 12 years
Gender: Female
MRI

Swelling and abnormal signal of the left hippocampus and the lower aspect of the left temporal lobe eliciting high signal at T2 and FLAIR WI. Mild degree of diffusion restriction.

Annotated image

Swelling and abnormal signal of the left hippocampus and the lower aspect of the left temporal lobe eliciting high signal at T2 and FLAIR WI (arrows).

Case Discussion

Transient brain MRI abnormalities following seizure activity have long been a recognized phenomenon.

Seizure-related MR signal changes are widely variable and can be observed in the area of epileptic focus or at distant sites reflecting seizure transmission along neuronal networks. Postictal MRI features include transient increased T2 and FLAIR signal in the cortex or the subcortical white matter, with some degree of mass effect. Reversible diffusion restriction and abnormal cortical enhancement have also been reported.

Long-term evolution of acute seizure associated MRI changes include:

  • complete resolution of the MR signal changes
  • evolution of atrophy in a location that showed initial swelling; a few reports have shown an evolution from acute seizure associated changes in the hippocampus to hippocampus sclerosis.
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Case information

rID: 84520
Published: 27th Nov 2020
Last edited: 2nd Dec 2020
Inclusion in quiz mode: Included

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