Lansberg M G, O'Brien M W, Norbash A M, Moseley M E, Morrell M, Albers G W
Stanford Stroke Center, UCSF Stanford Health Care, Palo Alto, CA 94304-1705, USA.
Neurology. 1999 Mar 23;52(5):1021-7. doi: 10.1212/wnl.52.5.1021.
To report neuroimaging findings in patients with complex partial status epilepticus.
During status epilepticus, neuroimaging may be used to exclude other neurologic conditions. Therefore, it is important to identify the neuroimaging features that are associated with status epilepticus. In addition, MRI characteristics may provide insight into the pathophysiologic changes during status epilepticus.
The history and neuroimaging examination results of three patients with complex partial status epilepticus were reviewed. Studies obtained during status epilepticus included diffusion-weighted MRI (DWI), MR angiography (MRA), postcontrast T1-weighted MRI, T2-weighted MRI, and CT. Follow-up MRI was obtained in two patients, and autopsy results were available for the third.
Some of the MRI and CT findings during partial status epilepticus mimicked those of acute ischemic stroke: DWI and T2-weighted MRI showed cortical hyperintensity with a corresponding low apparent diffusion coefficient, and CT showed an area of decreased attenuation with effacement of sulci and loss of gray-white differentiation. However, the lesions did not respect vascular territories, there was increased signal of the ipsilateral middle cerebral artery on MRA, and leptomeningeal enhancement appeared on postcontrast MRI. On follow-up imaging, the abnormalities had resolved, but some cerebral atrophy was present.
The radiologic characteristics of status epilepticus resemble those of ischemic stroke but can be differentiated based on lesion location and findings on MRA and postcontrast MRI. The MRI abnormalities indicated the presence of cytotoxic and vasogenic edema, hyperperfusion of the epileptic region, and alteration of the leptomeningeal blood-brain barrier. These changes reversed, but they resulted in some regional brain atrophy.
报告复杂部分性癫痫持续状态患者的神经影像学表现。
在癫痫持续状态期间，神经影像学可用于排除其他神经系统疾病。因此，识别与癫痫持续状态相关的神经影像学特征很重要。此外，MRI特征可能有助于深入了解癫痫持续状态期间的病理生理变化。
回顾了3例复杂部分性癫痫持续状态患者的病史和神经影像学检查结果。癫痫持续状态期间进行的检查包括扩散加权MRI（DWI）、磁共振血管造影（MRA）、增强后T1加权MRI、T2加权MRI和CT。对2例患者进行了随访MRI检查，第3例患者有尸检结果。
部分癫痫持续状态期间的一些MRI和CT表现类似于急性缺血性卒中：DWI和T2加权MRI显示皮质高信号，相应表观扩散系数降低，CT显示衰减区域，脑沟消失，灰白质分界不清。然而，病变并不局限于血管分布区域，MRA显示同侧大脑中动脉信号增强，增强后MRI显示软脑膜强化。随访成像时，异常已消失，但存在一些脑萎缩。
癫痫持续状态的放射学特征与缺血性卒中相似，但可根据病变位置以及MRA和增强后MRI的表现进行鉴别。MRI异常表明存在细胞毒性和血管源性水肿、癫痫区域的高灌注以及软脑膜血脑屏障的改变。这些变化已逆转，但导致了一些局部脑萎缩。
