Fazekas F, Kapeller P, Schmidt R, Stollberger R, Varosanec S, Offenbacher H, Fazekas G, Lechner H
Department of Neurology, Karl-Franzens University, Graz, Austria.
Epilepsia. 1995 Sep;36(9):946-9. doi: 10.1111/j.1528-1157.1995.tb01640.x.
The etiology of cerebral abnormalities after focal status epilepticus (SE) is unknown. Possible causes include hypoxia and the excessive release of excitatory amino acids. Magnetic resonance imaging (MRI) of a 21-year-old patient with "cryptogenic" continuous motor seizures showed swelling and signal hyperintensity of the contralateral parietotemporal cortex, the thalamus, and the ipsilateral cerebellum on T2-weighted images. These regions are connected by glutamatergic pathways. Proton magnetic resonance spectroscopy (MRS) of the cortical lesion yielded a signal peak at the resonance frequency of 2.29 ppm, suggesting a focal increase of glutamate or its degradation product glutamine. At 3-month follow-up, structural alterations had disappeared, but the N-acetyl-aspartate/choline ratio was still reduced in the previously abnormal area. These findings are the first to demonstrate the contribution of MRS to pathophysiologic studies of focal SE in humans and, in combination with the pattern of imaging abnormalities, support a major role of glutamate for seizure-related brain damage.
局灶性癫痫持续状态（SE）后脑异常的病因尚不清楚。可能的原因包括缺氧和兴奋性氨基酸的过度释放。一名患有“隐源性”持续性运动性癫痫的21岁患者的磁共振成像（MRI）显示，在T2加权图像上，对侧顶颞叶皮质、丘脑和同侧小脑出现肿胀和信号高增强。这些区域通过谷氨酸能通路相连。对皮质病变进行质子磁共振波谱（MRS）分析，在共振频率为2.29 ppm处产生一个信号峰，提示谷氨酸或其降解产物谷氨酰胺局部增加。在3个月的随访中，结构改变消失，但先前异常区域的N-乙酰天门冬氨酸/胆碱比值仍降低。这些发现首次证明了MRS对人类局灶性SE病理生理学研究的贡献，并且结合成像异常模式，支持谷氨酸在癫痫相关脑损伤中起主要作用。
