Status epilepticus

Case contributed by Dr Mostafa El-Feky

Presentation

Multiple seizure attacks for one week and admitted to the ICU after an attack of status epilepticus.

Patient Data

Age: 40 years
Gender: Female
MRI

Mild thickening and increased T2/FLAIR signal of the cerebral cortex and subcortical white matter of the right temporal and parietal lobes with restricted diffusion.

Case Discussion

These changes are mostly post-ictal changes (history of recent status epilepticus). Diffusion restriction occurs in severe attacks in which sustained seizure activity, results in hypoxia and eventually cell death. The involved areas here are the right temporoparietal cerebral cortex and subcortical white matter, right hippocampus and mesial temporal lobe.

Diffusion-weighted imaging has a prognostic role in status epilepticus. Unfortunately, when T2 signal elevation is associated with significant (>10%) drop in ADC values, follow-up is likely to reflect permanent damage 1.  

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Case information

rID: 66419
Published: 27th Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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