Investig Magn Reson Imaging.  2017 Jun;21(2):82-90. 10.13104/imri.2017.21.2.82.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

• Kim NY
• Baek HJ
• Choi DS
• Ha JY
• Shin HS
• Kim JH
• Choi HC
• Kim JE
• Park MJ

• KMID: 2385604
• DOI: http://doi.org/10.13104/imri.2017.21.2.82

Abstract

PURPOSE
This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period.
MATERIALS AND METHODS
From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions.
RESULTS
All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities.
CONCLUSION
Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

Keyword

Seizure; Cortical hyperintensity; Periictal period; Magnetic resonance imaging; Magnetic resonance angiography; Magnetic resonance perfusion

MeSH Terms

Angiography
Cerebral Arteries
Diagnosis
Diffusion
Dilatation
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Perfusion
Retrospective Studies
Seizures

Figure

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  Fig. 1 A 42-year-old male patient with seizure and dysarthria (patient 13). Axial FLAIR (a) and DWI (b) show cortical hyperintensities in the right cerebral cortices (short arrows) and ipsilateral thalamus (long arrows). On ADC map image (c), the lesions (except for the insula) reveal diffusion restriction (arrows). MR angiography (d) reveals marked dilatation with increased flow signal of the right middle cerebral artery (arrows). On follow-up FLAIR (e) and DWI (f) obtained 8 months later, there is diffuse atrophy of the right cerebral hemisphere.

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  Fig. 2 A 58-year-old male patient with seizure (patient 18). Axial FLAIR (a, b) and DWI (c, d) show multiple cortical hyperintensities in the right cerebral cortices (short arrows) and ipsilateral thalamus (long arrows). ADC map images (e, f) reveal restricted water diffusion of the lesions (arrows).

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  Fig. 3 A 75-year-old female patient with aphasia (aphasic status epilepticus) (patient 21). There are hyperintense lesions in the left temporooccipital lobes, hippocampus and thalamus (arrows) on DWI (a, b). On ACD map images (c, d), the lesions show restricted diffusion (arrows). Perfusion MR images (e, f) depict increased cerebral blood flow (e) and shortened time to peak (f) in the corresponding areas (arrows). On follow-up DWI (g, h) obtained 2 days later, the extent of lesions has decreased (arrows).

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