Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus

Department of Neurology, Ilsan Paik Hospital, Inje University, 2240 Daewha-dong, Ilsan-gu, Goyang-city, Gyonggi-do 411-706, South Korea.
Seizure (Impact Factor: 1.82). 08/2004; 13(5):317-21. DOI: 10.1016/j.seizure.2003.08.004
Source: PubMed

ABSTRACT

Diffusion-weighted imaging (DWI) has demonstrated a focal area of cytotoxic oedema during partial status epilepticus (PSE). However, vasogenic oedema related to the breakdown of the blood-brain-barrier (BBB) and ictal hyperperfusion could be the predominant DWI findings in the epileptogenic area during PSE. We report a case of PSE with ictal aphasia, right hemiparesis, and repetitive focal motor seizure of the right side. T2-weighted image (T2WI) and apparent diffusion coefficient (ADC) maps obtained during PSE showed an increased signal in the left temporo-parietal area, indicative of vasogenic oedema. EEG documented the ictal activities and single photon emission tomography (SPECT) showed asymmetrically increased perfusion in the corresponding area. Follow-up T2WI, DWI, and ADC maps obtained 3 months later showed the disappearance of the previous abnormalities. However, T2WI showed cortical atrophy and newly developed white matter changes in the corresponding area. This case shows that DWI findings may be variable during PSE, dependent on the predominance of cytotoxic and vasogenic oedema.

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    • "The timing of MRI acquisition has been proposed by some authors as one of the factors that could contribute to these apparently non-congruent findings regarding the TPMA ADC signal abnormalities (Briellmann et al., 2005; Hong et al., 2004). Animal experiments disclosed that, early after a seizure, the lactate levels increase and the ADC values decrease, with these changes attributed to the failure of the Na + /K + -ATPase pump and anaerobic metabolism (Najm et al., 1997; Righini et al., 1994; Wang et al., 1996); whereas the lactate changes are short-lived, the ADC value is maximally decreased at 24 hours, returning to the control level or increasing in the following 48 to 72 hours, when T2-weighted abnormalities emerge (Nakasu et al., 1995; Righini et al., 1994). "

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    • "This finding was thought to represent a shift of water into cortical cells at the seizure focus, and a shift of water into extracellular space in remote white matter due to vasogenic oedema (Lux et al., 1986). Similar findings in other case reports hint at the complex osmotic relationship between epileptogenic and surrounding areas, and cytotoxic and vasogenic oedema (Kim et al., 2001; Hong et al., 2004). Other studies have broadly corroborated these results including a small case series, where cortical ADC reductions of up to 36% were found during partial status epilepticus (Lansberg et al., 1999). "
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