Case Notes
History
24 year old female presenting with episode of of sudden disconnection, staring, and unresponsiveness lasting 1-2 minutes.Exam
MR diffusion
Prior Study
CT Head not availableT1-w MR
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.
T2-w MR
There is hyperacute, abnormal hippocampal change consistent with hyperacute hippocampal injuries. 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.
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.