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Magnetic resonance imaging changes related to acute seizure activity

Andrew J Cole, MD, FRCP(C)
Section Editor
Timothy A Pedley, MD
Deputy Editor
Janet L Wilterdink, MD


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 [1]. 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".)

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Literature review current through: Dec 2017. | This topic last updated: Sep 06, 2017.
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