Al-Chalabi Mustafa, Bajrami Silvi, Karim Nurose, Sheikh Ajaz
Department of Neurology, University of Toledo, Toledo, OH, USA.
College of Medicine and Life Sciences, University of Toledo, OH, USA.
eNeurologicalSci. 2022 May 21;27:100405. doi: 10.1016/j.ensci.2022.100405. eCollection 2022 Jun.
Brain MRI in Status Epilepticus (SE) is often helpful in diagnosis, lateralization and localization of the seizure focus. MRI changes in SE include predominantly ipsilateral diffusion weighted imaging (DWI) changes in the hippocampus and pulvinar or similar changes involving basal ganglia, thalamus, cerebellum, brain stem and external capsule (Chatzikonstantinou et al., 2011 [1]). These changes are thought to be due to transient vasogenic and cytotoxic edema due to either transient damage or breakdown of blood brain barrier, proportional to the frequency and duration of the epileptic activity (Amato et al., 2001 [2]). Such changes may also be reflected on T2- weighted and T2-Fluid-Attenuated Inversion Recovery (FLAIR) sequences of MRI. Herein, we present a case of a transient FLAIR cerebrospinal fluid (CSF) hyperintensity on the second MRI brain in a patient with focal status epilepticus. This imaging finding led to diagnostic confusion and was initially thought to represent subarachnoid hemorrhage. However, lumbar puncture, brain computed tomography (CT), and a follow-up brain MRI ruled out that possibility and other CSF pathologies. We concluded that the transient FLAIR changes in the second brain MRI were related to a rare imaging pitfall caused by Gadolinium enhancement of CSF on the FLAIR sequence, popularly referred to as hyperintense acute reperfusion marker (HARM).
癫痫持续状态（SE）的脑部磁共振成像（MRI）通常有助于癫痫病灶的诊断、定位及定侧。SE的MRI改变主要包括海马体和丘脑枕的同侧扩散加权成像（DWI）改变，或涉及基底神经节、丘脑、小脑、脑干及外囊的类似改变（Chatzikonstantinou等人，2011 [1]）。这些改变被认为是由于血脑屏障的短暂损伤或破坏导致的短暂血管源性和细胞毒性水肿，与癫痫活动的频率和持续时间成正比（Amato等人，2001 [2]）。此类改变也可能在MRI的T2加权和T2液体衰减反转恢复（FLAIR）序列上有所体现。在此，我们报告一例局灶性癫痫持续状态患者第二次脑部MRI出现短暂的FLAIR脑脊液（CSF）高信号的病例。这一影像学表现导致了诊断上的困惑，最初被认为是蛛网膜下腔出血。然而，腰椎穿刺、脑部计算机断层扫描（CT）及后续的脑部MRI排除了这种可能性及其他脑脊液病变。我们得出结论，第二次脑部MRI的短暂FLAIR改变与一种罕见的影像学陷阱有关，该陷阱是由钆在FLAIR序列上增强脑脊液所致，通常称为高信号急性再灌注标记（HARM）。
