Cohen-Gadol Aaron A, Britton Jeffrey W, Worrell Gregory A, Meyer Fredric B
Department of Neurologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Surg Neurol. 2004 May;61(5):479-82; discussion 482. doi: 10.1016/S0090-3019(03)00540-8.
Transient neuroimaging findings associated with seizure activity have received relatively little attention in the neurosurgical literature. These abnormalities may mimick neoplastic or ischemic changes on magnetic resonance imaging (MRI), possibly leading to additional studies and surgical treatment.
A 17-year-old right-handed male was transferred to emergency room in status epilepticus. A MRI obtained 5 months before admission was negative. On the day of admission, he had multiple intermittent upper-left extremity partial seizures and prolonged secondary generalized seizures. An electroencephalogram (EEG) showed frequent epileptiform discharges over the right hemisphere posteriorly. A MRI study performed 2 days after admission revealed non-hemorrhagic abnormalities involving the right occipital region that were hyperintense on fluid-attenuated inversion recovery (FLAIR) and T2 weighted sequences. The apparent diffusion coefficient map was unremarkable. Follow-up MRIs, 3 and 11 months after admission, showed complete resolution of these lesions.
Imaging findings after status epilepticus may raise suspicion of ischemic or neoplastic lesions. These findings may be reversible. Further follow-up imaging may prevent unnecessary intervention.
与癫痫发作活动相关的短暂性神经影像学表现，在神经外科文献中受到的关注相对较少。这些异常在磁共振成像（MRI）上可能类似肿瘤或缺血性改变，可能导致进一步的检查和手术治疗。
一名17岁右利手男性因癫痫持续状态被送至急诊室。入院前5个月进行的MRI检查结果为阴性。入院当天，他出现多次左上肢体间歇性部分性发作及长时间的继发性全身性发作。脑电图（EEG）显示右半球后部频繁出现癫痫样放电。入院2天后进行的MRI检查显示右枕叶区域存在非出血性异常，在液体衰减反转恢复（FLAIR）序列和T2加权序列上呈高信号。表观扩散系数图无明显异常。入院后3个月和11个月的随访MRI显示这些病变完全消失。
癫痫持续状态后的影像学表现可能会引起对缺血性或肿瘤性病变的怀疑。这些表现可能是可逆的。进一步的随访影像学检查可避免不必要的干预。
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