Soto-Ares G, Jissendi Tchofo P, Szurhaj W, Trehan G, Leclerc X
Service de Neuroradiologie, Hôpital Roger Salengro, CHRU de Lille, France.
J Neuroradiol. 2004 Sep;31(4):281-8. doi: 10.1016/s0150-9861(04)97007-1.
Neuroimaging evaluation in patients after a first seizure could be easily determined on the basis of seizure history, neurological examination, blood sample analysis and electroencephalography. The main objectives of the initial work-up are to differentiate a true seizure event from seizure-like symptoms, to exclude a single seizure as a manifestation of non organic cause and finally to consider the seizure as a result of cerebral lesion or inaugurate epilepsy. When a new onset seizure is diagnosed, urgent neuroimaging is recommended only in patients with focal neurological deficit, persistent or worsening alteration in the level of consciousness and when clinical and biological data lead to a suspected vascular or infectious etiology. Brain CT scan is usually more available in emergency to identify the cause of seizure. It may have an important role for the therapeutic strategy and may defer MRI investigation. Nevertheless, brain MRI must be performed in emergency when CT scan is not conclusive despite a severe clinical condition or in case of cerebral venous thrombosis. Imaging modalities depend on clinical data, patient age and suspected epilepsy type.
首次发作后患者的神经影像学评估可根据发作病史、神经系统检查、血液样本分析和脑电图轻松确定。初始检查的主要目的是将真正的癫痫发作事件与癫痫样症状区分开来，排除单一发作作为非器质性病因的表现，最后将发作视为脑部病变的结果或诊断为癫痫。当诊断出新发癫痫发作时，仅建议对有局灶性神经功能缺损、意识水平持续或恶化改变以及临床和生物学数据提示可疑血管或感染病因的患者进行紧急神经影像学检查。脑部CT扫描在急诊中通常更容易获得，以确定癫痫发作的原因。它可能对治疗策略具有重要作用，并且可能推迟MRI检查。然而，当CT扫描尽管临床情况严重但仍无定论或在发生脑静脉血栓形成的情况下，必须在急诊中进行脑部MRI检查。成像方式取决于临床数据、患者年龄和疑似癫痫类型。
