Seizure-induced brain lesions: A wide spectrum of variably reversible MRI abnormalities

Abstract Introduction MRI abnormalities in the postictal period might represent the effect of the seizure activity, rather than its structural cause. Material and Methods Retrospective review of clinical and neuroimaging charts of 26 patients diagnosed with seizure-related MR-signal changes. All pat...

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Bibliographic Details
Published in:European journal of radiology 2013-11, Vol.82 (11), p.1964-1972
Main Authors: Cianfoni, A, Caulo, M, Cerase, A, Della Marca, G, Falcone, C, Di Lella, G.M, Gaudino, S, Edwards, J, Colosimo, C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Algorithms
Brain - pathology
Child
Child, Preschool
Female
Humans
Image Interpretation, Computer-Assisted - methods
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Middle Aged
Radiology
Reproducibility of Results
Reversible changes
Seizure
Seizures - pathology
Sensitivity and Specificity
Young Adult
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Summary:Abstract Introduction MRI abnormalities in the postictal period might represent the effect of the seizure activity, rather than its structural cause. Material and Methods Retrospective review of clinical and neuroimaging charts of 26 patients diagnosed with seizure-related MR-signal changes. All patients underwent brain-MRI (1.5-Tesla, standard pre- and post-contrast brain imaging, including DWI-ADC in 19/26) within 7 days from a seizure and at least one follow-up MRI, showing partial or complete reversibility of the MR-signal changes. Extensive clinical work-up and follow-up, ranging from 3 months to 5 years, ruled out infection or other possible causes of brain damage. Seizure-induced brain-MRI abnormalities remained a diagnosis of exclusion. Site, characteristics and reversibility of MRI changes, and association with characteristics of seizures were determined. Results MRI showed unilateral (13/26) and bilateral abnormalities, with high (24/26) and low (2/26) T2-signal, leptomeningeal contrast-enhancement (2/26), restricted diffusion (9/19). Location of abnormality was cortical/subcortical, basal ganglia, white matter, corpus callosum, cerebellum. Hippocampus was involved in 10/26 patients. Reversibility of MRI changes was complete in 15, and with residual gliosis or focal atrophy in 11 patients. Reversibility was noted between 15 and 150 days (average, 62 days). Partial simple and complex seizures were associated with hippocampal involvement (p = 0.015), status epilepticus with incomplete reversibility of MRI abnormalities ( p = 0.041). Conclusions Seizure or epileptic status can induce transient, variably reversible MRI brain abnormalities. Partial seizures are frequently associated with hippocampal involvement and status epilepticus with incompletely reversible lesions. These seizure-induced MRI abnormalities pose a broad differential diagnosis; increased awareness may reduce the risk of misdiagnosis and unnecessary intervention.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2013.05.020