Department of Rehabilitation, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, PR China.
Pediatr Neurol. 2019 Mar;92:60-66. doi: 10.1016/j.pediatrneurol.2018.08.028. Epub 2018 Nov 23.
Unilateral brain edema is a rare peri-ictal imaging abnormality related to focal status epilepticus. We present the largest series of these patients, describe their clinical features and magnetic resonance imaging (MRI) findings, and analyze the possible underlying pathophysiology.
We reviewed the medical records in Southwest China's largest tertiary's children's medical center from 2011 to 2017. Patients with focal status epilepticus were included if acute-phase cerebral MRI showed unilateral edematous swelling of the epileptic hemisphere.
Eleven children were included. The age at which the patients presented with status epilepticus ranged from seven months to 10.8 years. All patients showed prolonged clonic seizures with marked unilateral predominance followed by hemiplegia of the ipsilateral limbs. The seizure duration ranged from one to 72 hours. All patients showed hyperintensities on T2-weighted images and diffusion-weighted images involving the whole pathologic hemisphere. Three patients showed involvement of the contralateral cerebellar hemisphere and one showed hippocampal herniation. Magnetic resonance angiography of the brain was performed in seven patients, among which three showed dilation of the affected hemispheric arteries. Three patients underwent follow-up MRI, and all the examinations revealed ipsilateral cerebral hemisphere atrophy.
Focal status epilepticus may cause unilateral brain edema, and cytotoxic edema probably plays an important role in the pathophysiology of brain injury.
单侧脑水肿是一种与局灶性癫痫持续状态相关的罕见发作间期影像学异常。我们呈现了最大系列的此类患者，描述了他们的临床特征和磁共振成像（MRI）表现，并分析了潜在的病理生理学机制。
我们回顾了 2011 年至 2017 年期间中国西南地区最大的三级儿童医院的病历。如果急性脑 MRI 显示癫痫半球单侧水肿性肿胀，则将局灶性癫痫持续状态患者纳入研究。
共纳入 11 例患儿。患者出现癫痫持续状态的年龄为 7 个月至 10.8 岁。所有患者均表现为持续性阵挛发作，伴有明显的单侧优势，随后出现同侧肢体偏瘫。发作持续时间从 1 小时到 72 小时不等。所有患者的 T2 加权图像和弥散加权图像均显示整个病变半球的高信号。3 例患者累及对侧小脑半球，1 例患者出现海马疝。7 例患者行脑磁共振血管造影检查，其中 3 例患者显示受累半球动脉扩张。3 例患者接受了随访 MRI 检查，所有检查均显示同侧大脑半球萎缩。
局灶性癫痫持续状态可能导致单侧脑水肿，细胞毒性水肿可能在脑损伤的病理生理学中起重要作用。
