Seizure-Induced Increased 18F-DOPA Uptake in a Child With Diffuse Astrocytoma and Transient Brain MRI Abnormalities Related to Status Epilepticus

Multi-system Inflammatory Syndrome in Children (MIS-C) is a post infectious inflammatory syndrome following COVID infection. Previous case series have demonstrated that CNS involvement is less common and presents heterogeneously. The following case describes an infant with an initial presentation of refractory febrile status epilepticus. Genetic testing later showed multiple variants of uncertain significance. The patient met clinical criteria for MIS-C and had a markedly abnormal brain MRI with bilateral diffuse restricted diffusion (anterior > posterior). Clinically, the patient improved with pulse steroids and IVIg. This case highlights the importance of maintaining MIS-C in the differential as a trigger of Febrile Infection Related Epilepsy Syndrome (FIRES) with multi-organ involvement presenting 2-4 weeks after infectious symptoms and COVID exposure.

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Cytotoxic lesion of the corpus callosum in a patient with aphasic status epilepticus

Journal of Applied Cognitive Neuroscience ◽

10.17981/10.17981/jacn.1.1.2020.15 ◽

2020 ◽

Vol 1 (1) ◽

pp. 98-100

Author(s):

Juan Ignacio Castiglione ◽

Mario Emiliano Ricciardi ◽

Catalina Bensi

Keyword(s):

Status Epilepticus ◽

Corpus Callosum ◽

Brain Mri ◽

Brain Regions ◽

Image Resolution ◽

High Signal ◽

Temporal Region ◽

Antiepileptic Treatment ◽

Sharp Waves ◽

Diffusion Weighted Images

A 47-year-old man with a history of aphasic seizures presented to the emergency room with a 12-hour global aphasia. Upon admission, brain MRI did not reveal acute lesions, and EEG showed sharp waves in the left frontal-temporal region. An Aphasic Status Epilepticus was diagnosed and antiepileptic treatment was initiated with adequate response. A week after the episode, a new brain MRI showed a high-signal ovoid lesion on T2-weighted and FLAIR sequences in the central part of the splenium of the corpus callosum. On diffusion-weighted images (DWI) the lesion was hyperintense with decreased apparent diffusion coefficient (ADC) values, indicating restricted diffusion consistent with a cytotoxic lesion of the corpus callosum (CLOCC). Follow-up MRI one month later showed complete image resolution. CLOCCs are secondary lesions associated with various entities in which high levels of cytokines and extracellular glutamate cause intracellular edema and reduced diffusion, a condition called cytotoxic edema, which affects vulnerable brain regions such as the splenium of the corpus callosum. In epileptic patients, CLOCCs may be due to the effect of seizures, especially prolonged ones, as well as antiepileptic treatment itself. CLOCCs are rare radiological findings and must be recognized to avoid misdiagnosis.

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Neurosyphilis Presenting As Status Epilepticus, Successively Hemiparesis And Aphasia

10.21203/rs.3.rs-1080272/v1 ◽

2021 ◽

Author(s):

Yunwen Qi ◽

Zongze Jiang ◽

Xiong Zhang ◽

Daixin Xie ◽

Zhiyou Cai

Keyword(s):

Status Epilepticus ◽

Brain Mri ◽

Case Presentation ◽

Fluid Analysis ◽

Penicillin Therapy ◽

History Of ◽

No Gold Standard ◽

Todd’S Paresis ◽

The Brain ◽

Better Than

Abstract Background: Neurosyphilis can occur anytime and present with a myriad of symptoms. Lissauer form of General Paresis Insane (GPI) is rare. We can learn more about this form of GPI through this case report.Case Presentation: The patient presented as status epilepticus, successively as hemiparesis and aphasia, which may be considered as the Todd's paresis or stroke. By performing the reactive serum rapid plasma reagent test and cerebrospinal fluid analysis, as well as the brain MRI results, we made the diagnosis as Lissauer form of GPI. The patient was started on intravenous penicillin for a total of 14 days. After that, the patient appeared with marked clinical improvement. Cognitive ability was better than before. Conclusions: GPI typically has a progressive course and normally presents 10 to 30 years after the initial infection. The manifestations of this patient and his suspicious history of Transient Ischemic Attacks (TIA) may mislead to the diagnosis of Todd's paresis or stroke. The prevalence of syphilis is rising again in recent years. To date, there is no gold standard for the diagnosis of neurosyphilis. Early diagnosis is of great importance as effective penicillin therapy is available.

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Prevalence, distribution, and clinical associations of suspected postictal changes on brain magnetic resonance imaging in epileptic dogs

Journal of the American Veterinary Medical Association ◽

10.2460/javma.21.02.0088 ◽

2022 ◽

pp. 1-11

Author(s):

Christian Maeso ◽

Daniel Sánchez-Masian ◽

Sergio Ródenas ◽

Cristina Font ◽

Carles Morales ◽

...

Keyword(s):

Status Epilepticus ◽

Confidence Interval ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Unknown Origin ◽

Mass Effect ◽

Idiopathic Epilepsy ◽

Seizure Type ◽

Mri Features ◽

Cluster Seizures

Abstract OBJECTIVE To determine the prevalence of presumed postictal changes (PC) on brain MRI in epileptic dogs, describe their distribution, and recognize possible correlations with different epilepsy features. ANIMALS 540 client-owned dogs with epilepsy and a complete medical record that underwent brain MRI at 4 veterinary referral hospitals between 2016 and 2019. PROCEDURES Data were collected regarding signalment, seizure type, seizure severity, time between last seizure and MRI, and etiological classification of epilepsy. Postictal changes were considered when solitary or multiple intraparenchymal hyperintense lesions were observed on T2-weighted and fluid-attenuated inversion recovery images and were hypointense or isointense on T1-weighted sequences, which were not confined to a vascular territory and showed no to mild mass effect and no to mild contrast enhancement. RESULTS Sixty-seven dogs (12.4%) showed MRI features consistent with PC. The most common brain sites affected were the piriform lobe, hippocampus, temporal neocortex, and cingulate gyrus. Dogs having suffered cluster seizures or status epilepticus were associated with a higher probability of occurrence of PC, compared to dogs with self-limiting seizures (OR 2.39; 95% confidence interval, 1.33 to 4.30). Suspected PC were detected both in dogs with idiopathic epilepsy and in those with structural epilepsy. Dogs with unknown-origin epilepsy were more likely to have presumed PC than were dogs with structural (OR 0.15; 95% confidence interval, 0.06 to 0.33) or idiopathic epilepsy (OR 0.42; 95% confidence interval, 0.20 to 0.87). Time between last seizure and MRI was significantly shorter in dogs with PC. CLINICAL RELEVANCE MRI lesions consistent with PC were common in epileptic dogs, and the brain distribution of these lesions varied. Occurrence of cluster seizures or status epilepticus, diagnosis of unknown origin epilepsy, and lower time from last seizure to MRI are predictors of suspected PC.

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A 9-year-old boy with acute psychosis and non-convulsive status epilepticus

European Psychiatry ◽

10.1016/s0924-9338(11)73420-4 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1716-1716 ◽

Cited By ~ 1

Author(s):

N. Fisch ◽

H. Goldberg-Stern ◽

S. Kivity ◽

D. Inbar ◽

A. Shuper

Keyword(s):

Status Epilepticus ◽

Benign Lesion ◽

Brain Mri ◽

Psychotic Symptoms ◽

Convulsive Status Epilepticus ◽

Acute Psychosis ◽

Causative Relationship ◽

Eeg Abnormalities ◽

Increased Risk ◽

Voltage Spike

Pediatric patients with epilepsy have an increased risk of ictal, postictal or interictal psychotic symptoms. We describe a child with mild epilepsy who was hospitalized in our Pediatric ward with acute severe psychosis. His epilepsy was well controlled and he was known to have a 4 mm large frontal cystic lesion per brain MRI. He did not have overt seizures upon admission, but his EEG showed non-convulsive, high voltage spike/slow wave activity. Treatment with valproic acid led to concomitant resolution of the psychotic symptoms and EEG abnormalities. Several months later psychotic symptoms recurred, this time in a milder form, again associated with the same EEG pattern. Lamotrigine was added to the treatment regimen and both symptoms and electrographic changes resolved. No change was noted on repeat MRI.This child presents an unusual relationship between acute psychosis and markedly abnormal EEG, both resolving with anti-epileptic medication, and a potential causative relationship to a frontal lesion. We discuss this unusual connection between the psychiatric (psychosis), epileptic (non-convulsive status epilepticus) and organic brain (frontal benign lesion) disorders in this child.

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NIMG-31. NON-DIPG PATIENTS ENROLLED IN THE INTERNATIONAL DIPG REGISTRY: HISTOPATHOLOGIC EVALUATION OF CENTRAL NEURO-IMAGING REVIEW

Neuro-Oncology ◽

10.1093/neuonc/noaa215.644 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii154-ii154

Author(s):

Margot Lazow ◽

Christine Fuller ◽

Adam Lane ◽

Mariko DeWire ◽

Pratiti Bandopadhayay ◽

...

Keyword(s):

Brain Mri ◽

Diffuse Intrinsic Pontine Glioma ◽

Imaging Features ◽

Diffuse Astrocytoma ◽

Embryonal Tumors ◽

Exact Probability ◽

Pilocytic Astrocytomas ◽

Diagnostic Biopsy ◽

Histopathologic Evaluation ◽

Neuro Imaging

Abstract INTRODUCTION The role of diagnostic biopsy in diffuse intrinsic pontine glioma (DIPG) remains in question. Distinguishing radiographically between DIPG and other pontine tumors with more favorable prognosis and different therapy is critically important. METHODS Cases submitted to the International DIPG registry with histopathologic data were analyzed. Central imaging review was performed on diagnostic brain MRI (if available) by two neuro-radiologists; all cases with imaging features or histopathology suggestive of alternative diagnoses were re-reviewed. Imaging features suggestive of alternative diagnoses included non-pontine origin, < 50% pontine involvement (without typical DIPG pattern on follow-up), focally exophytic morphology, sharply-defined margins, or marked diffusion restriction throughout. RESULTS Among 294 patients with pathology from biopsy and/or autopsy available, 27 (9%) had histologic diagnoses not consistent with DIPG, most commonly pilocytic astrocytomas (n=11) and embryonal tumors (n=9). Of these 294 patients with biopsy and/or autopsy pathologic data, 163 also had diagnostic MRI available for central neuroimaging review and radiographic comparison. Among 81 patients classified as characteristic of DIPG, 80 (99%) had histopathology consistent with DIPG (diffuse midline glioma, H3K27M-mutant, glioblastoma, anaplastic astrocytoma, diffuse astrocytoma). Among 63 patients classified as likely DIPG, but with unusual imaging features, 59 (94%) had histopathology consistent with DIPG. Nineteen patients had imaging features suggestive of another diagnosis, including 13 with non-pontine tumor origin; the remaining 6 patients all had histopathology not consistent with DIPG (embryonal tumors [n=3, including 1 with medulloblastoma], pilocytic astrocytoma [n=1], and ganglioglioma [n=1]). Association between central imaging review and histopathology was significant (p < 0.001 by the Freeman-Halton Fischer Exact Probability Test). CONCLUSIONS The important role and accuracy of central neuroimaging review in diagnosing or excluding DIPG is demonstrated. In patients with pontine tumors for which DIPG is felt unlikely radiographically, biopsy may be considered to guide diagnosis, prognosis, and treatment.

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Cryptogenic NORSE

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000396 ◽

2017 ◽

Vol 4 (6) ◽

pp. e396 ◽

Cited By ~ 29

Author(s):

Takahiro Iizuka ◽

Naomi Kanazawa ◽

Juntaro Kaneko ◽

Naomi Tominaga ◽

Yutaka Nonoda ◽

...

Keyword(s):

Status Epilepticus ◽

Clinical Features ◽

Brain Mri ◽

Ventilatory Support ◽

Autoimmune Encephalitis ◽

Refractory Status Epilepticus ◽

Oligoclonal Bands ◽

Term Outcome ◽

Long Term Outcome ◽

Nmda Receptor Encephalitis

Objective:To report the distinctive clinical features of cryptogenic new-onset refractory status epilepticus (C-NORSE) and the C-NORSE score based on initial clinical assessments.Methods:A retrospective study was conducted for 136 patients with clinically suspected autoimmune encephalitis who underwent testing for autoantibodies to neuronal surface antigens between January 1, 2007, and August 31, 2016. Eleven patients with C-NORSE were identified. Their clinical features were compared with those of 32 patients with anti-NMDA receptor encephalitis (NMDARE).Results:The clinical outcome of 11 patients (median age, 27 years; 7 [64%] women) with C-NORSE was evaluated after a median follow-up of 11 months (range, 6–111 months). Status epilepticus was frequently preceded by fever (10/11 [91%]). Brain MRIs showed symmetric T2/fluid-attenuated inversion recovery hyperintensities (8/11 [73%]) and brain atrophy (9/11 [82%]). Only 2 of the 10 treated patients responded to the first-line immunotherapy, and 4 of the 5 patients treated with IV cyclophosphamide responded to the therapy. The long-term outcome was poor in 8 patients (73%). Compared with 32 patients with NMDARE (median age, 27 years; 24 [75%] women), those with C-NORSE had more frequent prodromal fever, status epilepticus, ventilatory support, and symmetric brain MRI abnormalities, had less frequent involuntary movements, absent psychobehavioral symptoms, CSF oligoclonal bands, or tumor association, and had a worse outcome. The C-NORSE score was higher in patients with C-NORSE than those with NMDARE.Conclusions:Patients with C-NORSE have a spectrum of clinical-immunological features different from those with NMDARE. The C-NORSE score may be useful for discrimination between them. Some patients could respond to immunotherapy.

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Multilobar polymicrogyria, intractable drop attack seizures, and sleep-related electrical status epilepticus

Neurology ◽

10.1212/wnl.51.2.504 ◽

1998 ◽

Vol 51 (2) ◽

pp. 504-512 ◽

Cited By ~ 104

Author(s):

R. Guerrini ◽

P. Genton ◽

M. Bureau ◽

A. Parmeggiani ◽

X. Salas-Puig ◽

...

Keyword(s):

Status Epilepticus ◽

Brain Mri ◽

Cognitive Testing ◽

Sleep Eeg ◽

Seizure Outcome ◽

Drop Attack ◽

Cortical Malformations ◽

Intractable Seizures ◽

Age Related ◽

Eeg Recordings

Background and Objective: Patients with cortical malformations often have intractable seizures and are candidates for epilepsy surgery. Within an unselected series of patients with various forms of cortical malformation, nine patients with multilobar polymicrogyria had electrical status epilepticus during sleep (ESES) accompanied by infrequent focal motor seizures. Eight patients also had intractable atonic drop attack seizures. Because ESES usually is accompanied by a good long-term seizure prognosis, the objective of this study was to examine ESES outcome among patients with a structural lesion that is usually highly epileptogenic and has a low seizure remission trend.Methods: The nine patients had follow-up periods lasting 4 to 19 years. All underwent brain MRI, serial sleep EEG recordings, and cognitive testing during and after ESES.Results: ESES and drop attack seizures appeared between the ages of 2 and 5 years(mean, 4 years) and ceased between the ages of 5 and 12 years (mean, 8 years). At the last visit patients were 8 to 23 years of age (mean, 14.5 years) and were either seizure free or had very infrequent focal motor seizures during sleep. Three patients were free from antiepileptic drugs. In no patient was definite cognitive deterioration apparent after ESES in comparison with earlier evaluations.Conclusions: Age-related secondary bilateral synchrony underlying ESES may be facilitated in multilobar polymicrogyria. The good seizure outcome contrasts with that usually found in the presence of cortical malformations. For children with polymicrogyria and drop attack seizures, surgical treatment of the epilepsy should be considered cautiously, and sleep EEG recordings should be performed systematically.

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Clinically based score predicting cryptogenic NORSE at the early stage of status epilepticus

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000849 ◽

2020 ◽

Vol 7 (5) ◽

pp. e849

Author(s):

Atsuko Yanagida ◽

Naomi Kanazawa ◽

Juntaro Kaneko ◽

Atsushi Kaneko ◽

Ryoko Iwase ◽

...

Keyword(s):

Status Epilepticus ◽

Early Stage ◽

Brain Mri ◽

Ventilatory Support ◽

Antibody Test ◽

Refractory Status Epilepticus ◽

Test Results ◽

Tumor Association ◽

Unclear Etiology ◽

Score Range

ObjectiveTo determine whether a clinically based score predicts cryptogenic new-onset refractory status epilepticus (C-NORSE) at the early stage of status epilepticus (SE) with prominent motor symptoms (SE-M) of unclear etiology.MethodsThe score (range 0–6) included 6 clinical features: highly refractoriness to antiseizure drugs, previously healthy individual, presence of prodromal fever, absence of prodromal psychobehavioral or memory alterations, absence of dyskinesias, and symmetric brain MRI abnormalities (the first 2 mandatory). We retrospectively assessed the usefulness of a high scale score (≥5) in predicting C-NORSE in 83 patients with SE-M of unclear etiology, who underwent testing for neuronal surface antibodies (NS-Abs) between January 2007, and December 2019.ResultsThirty-one (37.3%) patients had a high score. Patients with a high score had more frequent prodromal fever (28/31 vs 24/52), mechanical ventilatory support (31/31 vs 36/52), and symmetric MRI abnormalities (26/31 vs 12/52), had less frequent involuntary movements (2/31 vs 30/52), and had absent prodromal psychobehavioral alterations (0/31 vs 27/52), CSF oligoclonal band detection (0/27 vs 11/38), tumor association (0/31 vs 13/52), or NS-Abs (0/31 vs 29/52) than those with a low score (<5). Thirty-three patients (median age, 27 years; 18 [54.5%] female) were finally regarded as C-NORSE. The sensitivity and specificity of a high score for predicting C-NORSE were 93.9% (95% CI 0.87–0.94) and 100% (95% CI 0.95–1.00), respectively.ConclusionsPatients with a high score in the indicated scale are more likely to have C-NORSE, making it a useful diagnostic tool at the early stage of SE-M before antibody test results become available.

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The role of brain MRI in status epilepticus

10.36295/asro.2020.23135 ◽

2020 ◽

Vol 23 (01) ◽

pp. 268-276

Author(s):

Yahya Mohammed Yaseen ◽

Dr. Noor Kathem Nee'ma Al-Waely ◽

Hasan Azeez Al-Hamadani

Keyword(s):

Status Epilepticus ◽

Brain Mri

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