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癫痫急性发作相关的磁共振成像改变

Author
Andrew J Cole, MD, FRCP(C)
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
张长青, 主治医师

引言

在磁共振成像(magnetic resonance imaging, MRI)问世前，对癫痫围发作期神经影像学检查的改变已有认识，体现在对部分癫痫发作患者的计算机断层扫描(computed tomography, CT)检查异常的报告。在CT扫描成像中，大脑沟回标志消失和斑片状对比增强的表现似乎可与癫痫活动发作的来源共同定位[1]。随着MRI成为评估癫痫发作与癫痫症患者的标准，越来越多的癫痫围发作期的成像发现已被描述。对这些影像学发现的了解十分重要，因为[2-4]：

  • 这些表现可能与其他局灶性病变(如脑肿瘤和脑卒中)相混肴，导致不恰当的治疗或检查。
  • 这些表现可能有助于手术方案的制定。
  • 这些表现可能有助于阐明癫痫发作的病理生理学。

本专题将探讨癫痫发作时以及发作后早期的MRI表现；我们将这些表现统称为癫痫围发作期。MRI或其他神经影像学检查技术在癫痫发作和癫痫症诊断中的应用，以及在癫痫症患者术前评估中的应用将单独讨论。 (参见“成人首次癫痫发作的评估”)

癫痫围发作期的局部MRI表现

癫痫围发作期成像改变可能发生于癫痫放电的区域(局部)或远端结构(远端)。表格中总结了这些发现(表 1)。

局部解剖学异常 — 局部解剖学异常指局限于海马或癫痫放电部位的异常，包括[3-21]:

        

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Literature review current through: 2017-06 . | This topic last updated: 2015-07-09.
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