Magnetic source imaging, which combines magnetoencephalography with structural MRI, can guide depth electrode placement in patients with a potential epileptogenic lesion that is not apparent on the MR images or with surface electroencephalographic findings that are discordant [56]. New-onset seizures in an adult require contrast-enhanced imaging in addition to routine MRI sequences [18]. MSI shows dipole clusters localized to posterior aspect of superior frontal gyrus, which correlates with electroencephalographic findings. Initial MR Imaging. High-resolution MRI is necessary to anatomically define macroscopic epileptogenic lesions. Comparison of 1.5-T and 3-T MRI. Mean age at seizure onset was 4.2 years (1-18). Reduced anisotropy and increased diffusivity have been found in the white matter subjacent to the dysplastic cortex both within and adjacent to magnetoencephalographic dipole clusters, probably at least partly related to abnormal myelin. Thirty to forty percent of patients have epilepsy refractory to pharmacologic management, and many of these patients can be effectively treated with epilepsy surgery [4]. For each antibody, we illustrate their pathophysiology, characteristic clinical presentations with typical effective treatments and prognoses and imaging findings on MRI and PET/CT exams. Unfortunately, lesion location is not a reliable distinguishing characteristic. Imaging of these conditions is fairly straightforward, and findings should be apparent on routine-protocol brain MR images. D, Magnetic source imaging (MSI) with magnetoencephalographic data overlayedon coronal (A), sagittal (B), and axial (C) T1-weighted MRI and surface-rendered model (D). 9B —36-year-old woman with type IIa focal cortical dysplasia. Dural enhancement extends along tentorium (arrowheads, D). A meta-analysis showed that the odds of becoming seizure free after surgery were 2.5 times higher in patients with defined lesions present on MR images or at histopathologic examination [7]. Magnetic resonance imaging (MRI). Such enhancements facilitate detection of cortical lesions, especially subtle cortical dysplasia. A pial or Although seizures are reported to be the most common clinical presentation, the clinical link between neurocysticercosis and epilepsy is inconsistent [47, 48]. Auras are variable in symptomatology, and include: 1. viscerosensory aura 1.1. typically from l… Failure to inspect entire skull base for defects can lead to delay in diagnosis. Results Among the 597 individuals (58% male, median age 38 years) with MRI scans analyzed, 488 (82%) had active epilepsy. focal epilepsy and unremarkable MRI have a 42% chance to have their seizures controlled with antiepileptic drugs, whereas this is true in 54% of cases with poststroke epilepsy; conversely, seizure control with medication was achieved in <10% of patients with hippocampal sclerosis on MRI… Indiscriminate use of IV contrast material in the evaluation of seizures in young children is not indicated, unless there is a known or suspected history of infection, neoplasm, or phakomatosis [19]. Another finding is a blurred interface between grey and white matter, because the white matter looks a little bit like gray matter because it contains neurons that did not reach the cortex. The MRI findings were compared with 2 previous similar studies in the United Kingdom. Neonatal encephalopathy with seizures (NEwS; OMIA: 001471-9615), an autosomal recessive disease reported in Standard Poodle puppies, is caused by a homozygous missense mutation in the activating … Blood tests. Thin-slice CT with multiplanar reformations is helpful for confirming associated bony abnormalities, which may range from pitting defects in the greater sphenoid wing, resembling changes secondary to arachnoid granulations, to regions of frank osseous dehiscence (Fig. CONCLUSION. SWI is more sensitive than imaging with conventional GRE sequences in depicting small hemorrhagic lesions [46]. An 11% incidence of MRI abnormalities in patients with simple FS is a novel finding, however, and suggests that febrile seizures are less benign than generally assumed. The success of epilepsy surgery is directly correlated with the ability to completely resect the epileptogenic zone, defined as the minimum amount of cortex that must be resected to provide seizure freedom. 7C —Examples of Taylor IIb focal cortical dysplasia. The most common extrahippocampal abnormalities are cortical malformations, such as dysplasia and heterotopia [26]. Mild T2 hyperintensity is sometimes apparent in the cortex [35]. Failure to detect meningoencephaloceles may be attributed to limitations imposed by the imaging parameters used, lack of meticulous inspection of the anterior temporal lobe and skull base, or a combination of these factors. A, 6-year-old girl with complex partial seizures and hippocampal sclerosis. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. In patients with no lesion identified on MRI, MSI can guide depth electrode placement. Dual pathologic mechanisms—the coexistence of HS with extrahippocampal pathologic findings—are estimated to occur in approximately 15% of cases. An estimated 2.2 million Americans have epilepsy, and the incidence is nearly 150,000 new cases annually. C, 21-year-old woman with temporal lobe epilepsy and anterior temporal lobe epilepsy and anterior temporal lobe white matter abnormalities. Six were excluded, one due to an acute stroke, one due to a tumor near the region of interest and 4 because of suspected encephalitis. Her seizures arose from the right frontotemporal area on EEG (figure 1). Please check your email for instructions on resetting your password. In patients with epilepsy, ipsilateral hippocampal inversion may reflect altered brain development affecting other parts of the brain but is not itself a cause of epilepsy [29]. Access from your IP address has been blocked. Brain imaging with MRI identifies structural cerebral pathology that may give rise to seizures. Do surface coils provide additional information? A, 33-year-old woman with tonic-clonic seizures and multiple small temporal lobe. These findings suggested that those reversible abnormalities were not structural but functional, possibly resulting from the cerebral edema induced by seizure ac tivity (Goulatia et al. Sagittal T1-weighted image shows frontoethmoidal encephalocele (arrow). Coronal T2-weighted FLAIR images (3-mm slice thickness, no interspace gap) are useful for confirming hippocampal T2 signal abnormalities and for detecting cortical and subcortical signal abnormalities related to FCD. Some FCDs are commonly overlooked because of small size or location at the bottom of a sulcus [14]. This is for good reason, because HS is by far the most common cause of TLE, present in 60–80% of surgical and autopsy specimens of patients with TLE [20]. 3B and 3C). The physiologic basis for these techniques is the general tendency for cortical glucose metabolism and blood flow to be increased in the epileptogenic focus during a seizure and decreased in the postictal and interictal periods [49]. They are most commonly related to congenital lesions or lesions that develop early in life, presumably reflecting increased vulnerability of the hippocampus in early childhood. 1B —21-year-old woman with complex partial seizures. C, 11-year-old boy with type IIb focal cortical dysplasia. B, 33-year-old woman with tonic-clonic seizures and multiple small temporal lobe. On CT images, DNETs are hypoattenuating masses with calcifications uncommonly present [33]. Repeat MRI of the brain showed symmetrical T2-weighted hyperintense lesions affecting the cerebral grey matter bilaterally suggestive of cerebral atrophy and polioencephalomalacia. 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