Finn Michael A, Blumenthal Deborah T, Salzman Karen L, Jensen Randy L
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT 84132-2303, USA.
Surg Neurol. 2007 Mar;67(3):246-50; discussion 250. doi: 10.1016/j.surneu.2006.04.015. Epub 2006 Nov 3.
Transient postictal imaging abnormalities in patients with non-tumor-related seizures are well documented and include fluid-attenuated inversion recovery/T2 hyperintensity and parenchymal and meningeal contrast enhancement. In contrast, transient postictal imaging abnormalities in patients with tumor-related seizures have been poorly described. Fifty percent of patients with brain tumors have a seizure during the course of their illness and are often imaged after a seizure or after a change in seizure character or frequency. Interval changes on repeat imaging can mimic disease progression or other pathologic processes.
We describe 3 patients with brain tumors and transient postictal MRI changes that mimicked disease progression and infection.
Our patients demonstrated fluid-attenuated inversion recovery/T2 hyperintensity and gadolinium enhancement on MRI studies performed shortly after ictal events. These changes were suspicious for tumor progression in 2 cases and for recurrent infection in the third. Control of seizure activity resulted in resolution of these changes on scans obtained 10 to 21 days later.
Imaging shortly after an ictal event can potentially mislead the clinician to interpret changes as tumor or pathologic progression. Unnecessary intervention in these patients with new and suspicious imaging findings should be avoided. We recommend repeat imaging be performed in patients with brain tumors and seizures several weeks after seizure control if clinically feasible. Further research is needed to delineate the time course of seizure-induced MRI changes.
非肿瘤相关性癫痫患者发作后短暂的影像学异常已有充分记录，包括液体衰减反转恢复序列/T2高信号以及实质和脑膜对比增强。相比之下，肿瘤相关性癫痫患者发作后短暂的影像学异常描述较少。50%的脑肿瘤患者在病程中会发生癫痫发作，且常在发作后、发作特征或频率改变后进行影像学检查。重复影像学检查的间期变化可能会模拟疾病进展或其他病理过程。
我们描述了3例脑肿瘤患者，其发作后MRI的短暂变化模拟了疾病进展和感染。
我们的患者在发作事件后不久进行的MRI检查中显示出液体衰减反转恢复序列/T2高信号和钆增强。这些变化在2例中可疑为肿瘤进展，在第3例中可疑为复发性感染。癫痫活动得到控制后，在10至21天后进行的扫描中这些变化消失。
发作事件后不久进行的影像学检查可能会误导临床医生将变化解释为肿瘤或病理进展。应避免对这些有新的可疑影像学发现的患者进行不必要的干预。如果临床可行，我们建议在癫痫控制数周后对脑肿瘤合并癫痫的患者进行重复影像学检查。需要进一步研究来明确癫痫诱发的MRI变化的时间进程。
