Hyperacute Seizure 02 - Clinical Case Summary
Hyperacute Seizure 02 - Clinical Case Summary
Hyperacute Seizure 02 - Clinical Case Summary
SummaryHistory
24 yo female presenting with episode of of sudden disconnection, staring, and unresponsiveness lasting 1-2 minutes.
Exams Performed
MR T1-w pre and/or post contrast; MR Coronal T2-w spin echo and MR FLAIR; MR diffusion
Prior available imaging reports
CT Head not available
T1-w MR pre and post
1. There is evidence of bilateral hippocampal changes with symmetric tissue edema. The post contrast T1-w sequence demonstrates abnormal tissue hyperemia in the bodies of both hippocampi (likely related to post seizure dysautoregulation). The presence of bilateral, symmetric hippocampal edema plus abnormal contrast enhancement is indicative of a greater depth and duration seizure event. Correlate with T2-w sequences and MR diffusion for possible features of status epilepticus.
MR Coronal T2-w spin echo and MR FLAIR
1. There is hyperacute, abnormal hippocampal change consistent with hyperacute hippocampal injuries plus a focal area of hyperintensity affecting the mesial occipital cortex adjacent to the splenium. The bilaterality of the hippocampal swelling plus the abnormal tissue enhancement on the post contrast T1-w sequence is consistent with a hyperacute seizure event with enough depth and duration to consider concurrent status epilepticus. The clinical service needs to be called immediately to insure that medical therapy has been instituted.
2. The MR flair sequence demonstrates no obvious evidence of post seizure injury within the remaining limbic system. There is no evidence of a concurrent foreign tissue lesion. There is nonspecific enlargement of the splenium of the corpus callosum, which by itself is not definitive, but splenial injury can be a part of status epilepticus.
MR Diffusion (DWI)
1. There is minimal T2-w shine-through hyperintensity of the DWI map within the hippocampi.
2. There is prominent MR diffusion signal increase within the splenium of the corpus callosum on the b=1000 DWI with subtle positive signal on the ADC map raising the possibilty of acute splenial injury, which is known to occur with a more prolonged depth and duration seizure event.
MR Susceptibility (SWI) not available
T1-w MR pre and post
1. There is evidence of bilateral hippocampal changes with symmetric tissue edema. The post contrast T1-w sequence demonstrates abnormal tissue hyperemia in the bodies of both hippocampi (likely related to post seizure dysautoregulation). The presence of bilateral, symmetric hippocampal edema plus abnormal contrast enhancement is indicative of a greater depth and duration seizure event. Correlate with T2-w sequences and MR diffusion for possible features of status epilepticus.
MR Coronal T2-w spin echo and MR FLAIR
1. There is hyperacute, abnormal hippocampal change consistent with hyperacute hippocampal injuries plus a focal area of hyperintensity affecting the mesial occipital cortex adjacent to the splenium. The bilaterality of the hippocampal swelling plus the abnormal tissue enhancement on the post contrast T1-w sequence is consistent with a hyperacute seizure event with enough depth and duration to consider concurrent status epilepticus. The clinical service needs to be called immediately to insure that medical therapy has been instituted.
2. The MR flair sequence demonstrates no obvious evidence of post seizure injury within the remaining limbic system. There is no evidence of a concurrent foreign tissue lesion. There is nonspecific enlargement of the splenium of the corpus callosum, which by itself is not definitive, but splenial injury can be a part of status epilepticus.
MR Diffusion (DWI)
1. There is minimal T2-w shine-through hyperintensity of the DWI map within the hippocampi.
2. There is prominent MR diffusion signal increase within the splenium of the corpus callosum on the b=1000 DWI with subtle positive signal on the ADC map raising the possibilty of acute splenial injury, which is known to occur with a more prolonged depth and duration seizure event.
MR Susceptibility (SWI) not available
Overall impression
1. Bilateral hyperacute hippocampal edema consistent with recent seizure event. There is also cortical cytogenic change in the splenium of the corpus callosum and in the mesial left occipital cortex. The combination of findings is consistent with status epilepticus.
Lessons to be Learned
More prolonged depth and or duration of a seizure event will produce bilateral hippocampal post seizure changes and limbic system or splenial changes indicates that there has been a period of status epilepticus.
