Magnetic resonance imaging changes related to acute seizure activity
- Andrew J Cole, MD, FRCP(C)
Andrew J Cole, MD, FRCP(C)
- Professor of Neurology
- Harvard Medical School
The recognition of periictal changes on neuroimaging studies predates magnetic resonance imaging (MRI), with reports of computed tomography (CT) abnormalities in occasional patients presenting with seizures. These findings of effacement of gyral markings and patchy contrast enhancement appeared to co-localize with the source of the ictal activity . As MRI has become standard in the evaluation of patients with seizures and epilepsy, a growing range of periictal imaging findings have been described. Knowledge of these findings is important because [2-4]:
●These findings may be confused with other focal pathology such as brain tumor, stroke or encephalitis, leading to inappropriate treatments or investigations.
●These findings may be helpful in surgical planning.
●These findings may help elucidate pathophysiology of epileptic seizures.
This topic discusses ictal and early postictal findings on MRI; we will refer to these findings together as periictal. The use of MRI and other neuroimaging techniques in the diagnosis of seizures and epilepsy and in presurgical evaluation of epilepsy patients is discussed separately. (See "Surgical treatment of epilepsy in adults" and "Evaluation and management of the first seizure in adults".)
- Goulatia RK, Verma A, Mishra NK, Ahuja GK. Disappearing CT lesions in epilepsy. Epilepsia 1987; 28:523.
- Cole AJ. Status epilepticus and periictal imaging. Epilepsia 2004; 45 Suppl 4:72.
- Lansberg MG, O'Brien MW, Norbash AM, et al. MRI abnormalities associated with partial status epilepticus. Neurology 1999; 52:1021.
- Briellmann RS, Wellard RM, Jackson GD. Seizure-associated abnormalities in epilepsy: evidence from MR imaging. Epilepsia 2005; 46:760.
- Doherty CP, Cole AJ, Grant PE, et al. Multimodal longitudinal imaging of focal status epilepticus. Can J Neurol Sci 2004; 31:276.
- VanLandingham KE, Heinz ER, Cavazos JE, Lewis DV. Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions. Ann Neurol 1998; 43:413.
- Raghavendra S, Ashalatha R, Krishnamoorthy T, et al. Reversible periictal MRI abnormalities: clinical correlates and long-term outcome in 12 patients. Epilepsy Res 2007; 73:129.
- Diehl B, Najm I, Ruggieri P, et al. Postictal diffusion-weighted imaging for the localization of focal epileptic areas in temporal lobe epilepsy. Epilepsia 2001; 42:21.
- Hufnagel A, Weber J, Marks S, et al. Brain diffusion after single seizures. Epilepsia 2003; 44:54.
- Costello DJ, Simon MV, Eskandar EN, et al. Efficacy of surgical treatment of de novo, adult-onset, cryptogenic, refractory focal status epilepticus. Arch Neurol 2006; 63:895.
- Diehl B, Najm I, Ruggieri P, et al. Periictal diffusion-weighted imaging in a case of lesional epilepsy. Epilepsia 1999; 40:1667.
- Fazekas F, Kapeller P, Schmidt R, et al. Magnetic resonance imaging and spectroscopy findings after focal status epilepticus. Epilepsia 1995; 36:946.
- Nagasaka T, Shindo K, Hiraide M, et al. Ipsilateral thalamic MRI abnormality in an epilepsy patient. Neurology 2002; 58:641.
- Meierkord H, Wieshmann U, Niehaus L, Lehmann R. Structural consequences of status epilepticus demonstrated with serial magnetic resonance imaging. Acta Neurol Scand 1997; 96:127.
- Yaffe K, Ferriero D, Barkovich AJ, Rowley H. Reversible MRI abnormalities following seizures. Neurology 1995; 45:104.
- Szabo K, Poepel A, Pohlmann-Eden B, et al. Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain 2005; 128:1369.
- Kim JA, Chung JI, Yoon PH, et al. Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol 2001; 22:1149.
- Toledo M, Munuera J, Sueiras M, et al. MRI findings in aphasic status epilepticus. Epilepsia 2008; 49:1465.
- Wieshmann UC, Symms MR, Shorvon SD. Diffusion changes in status epilepticus. Lancet 1997; 350:493.
- Heinrich A, Runge U, Kirsch M, Khaw AV. A case of hippocampal laminar necrosis following complex partial status epilepticus. Acta Neurol Scand 2007; 115:425.
- Boyd JG, Taylor S, Rossiter JP, et al. New-onset refractory status epilepticus with restricted DWI and neuronophagia in the pulvinar. Neurology 2010; 74:1003.
- Silverstein AM, Alexander JA. Acute postictal cerebral imaging. AJNR Am J Neuroradiol 1998; 19:1485.
- Gong G, Shi F, Concha L, et al. Insights into the sequence of structural consequences of convulsive status epilepticus: a longitudinal MRI study. Epilepsia 2008; 49:1941.
- Prichard JW, Neil JJ. Diffusion-weighted MRI: periictal studies. Adv Neurol 2000; 83:279.
- Förster A, Griebe M, Gass A, et al. Diffusion-weighted imaging for the differential diagnosis of disorders affecting the hippocampus. Cerebrovasc Dis 2012; 33:104.
- Leonhardt G, de Greiff A, Weber J, et al. Brain perfusion following single seizures. Epilepsia 2005; 46:1943.
- Rowe CC, Berkovic SF, Sia ST, et al. Localization of epileptic foci with postictal single photon emission computed tomography. Ann Neurol 1989; 26:660.
- O'Brien TJ, So EL, Cascino GD, et al. Subtraction SPECT coregistered to MRI in focal malformations of cortical development: localization of the epileptogenic zone in epilepsy surgery candidates. Epilepsia 2004; 45:367.
- O'Brien TJ, So EL, Mullan BP, et al. Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology 1998; 50:445.
- O'Brien TJ, So EL, Mullan BP, et al. Subtraction SPECT co-registered to MRI improves postictal SPECT localization of seizure foci. Neurology 1999; 52:137.
- Penfield, W. The evidence for a cerebral vascular mechanism in epilepsy. Ann Intern Med 1933; 7:303.
- Chakravarty A. MR evaluation of crossed and uncrossed cerebral-cerebellar diaschisis. Acta Neurol Scand 2003; 108:60.
- Mewasingh LD, Christiaens F, Aeby A, et al. Crossed cerebellar diaschisis secondary to refractory frontal seizures in childhood. Seizure 2002; 11:489.
- Bohnen NI, O'Brien TJ, Mullan BP, So EL. Cerebellar changes in partial seizures: clinical correlations of quantitative SPECT and MRI analysis. Epilepsia 1998; 39:640.
- Stübgen JP. Crossed cerebellar diaschisis related to recurrent focal seizures. Epilepsia 1995; 36:316.
- Katramados AM, Burdette D, Patel SC, et al. Periictal diffusion abnormalities of the thalamus in partial status epilepticus. Epilepsia 2009; 50:265.
- Natsume J, Bernasconi N, Andermann F, Bernasconi A. MRI volumetry of the thalamus in temporal, extratemporal, and idiopathic generalized epilepsy. Neurology 2003; 60:1296.
- Oster J, Doherty C, Grant PE, et al. Diffusion-weighted imaging abnormalities in the splenium after seizures. Epilepsia 2003; 44:852.
- Mirsattari SM, Lee DH, Jones MW, Blume WT. Transient lesion in the splenium of the corpus callosum in an epileptic patient. Neurology 2003; 60:1838.
- Polster T, Hoppe M, Ebner A. Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry 2001; 70:459.
- Kim SS, Chang KH, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999; 20:125.
- Cohen-Gadol AA, Britton JW, Jack CR Jr, et al. Transient postictal magnetic resonance imaging abnormality of the corpus callosum in a patient with epilepsy. Case report and review of the literature. J Neurosurg 2002; 97:714.
- Prilipko O, Delavelle J, Lazeyras F, Seeck M. Reversible cytotoxic edema in the splenium of the corpus callosum related to antiepileptic treatment: report of two cases and literature review. Epilepsia 2005; 46:1633.
- Carrara G, Ferlazzo E, Tampieri D, et al. Transient edematous lesions of the splenium in epileptic patients. Can J Neurol Sci 2005; 32:352.
- Gürtler S, Ebner A, Tuxhorn I, et al. Transient lesion in the splenium of the corpus callosum and antiepileptic drug withdrawal. Neurology 2005; 65:1032.
- Gröppel G, Gallmetzer P, Prayer D, et al. Focal lesions in the splenium of the corpus callosum in patients with epilepsy. Epilepsia 2009; 50:1354.
- Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:494.
- Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol 2002; 23:1038.
- Bakshi R, Bates VE, Mechtler LL, et al. Occipital lobe seizures as the major clinical manifestation of reversible posterior leukoencephalopathy syndrome: magnetic resonance imaging findings. Epilepsia 1998; 39:295.
- Grant PE, He J, Halpern EF, et al. Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain. Radiology 2001; 221:43.
- Oh JB, Lee SK, Kim KK, et al. Role of immediate postictal diffusion-weighted MRI in localizing epileptogenic foci of mesial temporal lobe epilepsy and non-lesional neocortical epilepsy. Seizure 2004; 13:509.
- Riela AR, Sires BP, Penry JK. Transient magnetic resonance imaging abnormalities during partial status epilepticus. J Child Neurol 1991; 6:143.
- Mathews MS, Smith WS, Wintermark M, et al. Local cortical hypoperfusion imaged with CT perfusion during postictal Todd's paresis. Neuroradiology 2008; 50:397.
- Eastwood JD, Lev MH, Wintermark M, et al. Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke. AJNR Am J Neuroradiol 2003; 24:1869.