Multiple seizure attacks for one week and admitted to the ICU after an attack of status epilepticus.
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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.
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.
- 1. Kim JA, Chung JI, Yoon PH, Kim DI, Chung TS, Kim EJ, Jeong EK. Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. (2001) AJNR. American journal of neuroradiology. 22 (6): 1149-60. Pubmed