Hyperacute Seizure 03 - Clinical Case Summary
Hyperacute Seizure 03 - Clinical Case Summary
Hyperacute Seizure 03 - Clinical Case Summary
SummaryHistory
56 yo female with sudden inability to speak clearly and confusion. There is history of alcoholism.
Exams Performed
CT head; 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
1. Possible left hippocampal edema, otherwise the noncontrast head CT is within normal limits.
T1-w MR pre and post
1. There is increased size the left hippocampus associated with increased venous hyperemia consistent with recent seizure activity.
T2-w coronal and T2- Flair
1. The coronal T2-w MR sequence demonstrates evidence of acute post seizure changes involving the head/body/tail and both transition segments of the left hippocampus.
2. The coronal T2-w spin-echo MR sequence evidence of acute post seizure changes involving only the body-tail transition zone of the right hippocampus.
3. The remainder of the exam is unremarkable for chronological age.
MR Diffusion (DWI)
1. The MR diffusion is positive for most of the left-sided hippocampus related to tissue edema. However, there is a small area in the mid, left hippocampal body the does appear to be water restricted being somewhat positive on both the DWI and ADC maps. There is a small subsegment abnormality in the caudal right hippocampus, as well.
MR Susceptibility (SWI) not available
1. Possible left hippocampal edema, otherwise the noncontrast head CT is within normal limits.
T1-w MR pre and post
1. There is increased size the left hippocampus associated with increased venous hyperemia consistent with recent seizure activity.
T2-w coronal and T2- Flair
1. The coronal T2-w MR sequence demonstrates evidence of acute post seizure changes involving the head/body/tail and both transition segments of the left hippocampus.
2. The coronal T2-w spin-echo MR sequence evidence of acute post seizure changes involving only the body-tail transition zone of the right hippocampus.
3. The remainder of the exam is unremarkable for chronological age.
MR Diffusion (DWI)
1. The MR diffusion is positive for most of the left-sided hippocampus related to tissue edema. However, there is a small area in the mid, left hippocampal body the does appear to be water restricted being somewhat positive on both the DWI and ADC maps. There is a small subsegment abnormality in the caudal right hippocampus, as well.
MR Susceptibility (SWI) not available
Overall impression
1. There are changes consistent with a prolonged seizure affecting the left hippocampus. The entire left is involved and significantly, there is actual water restriction within the body of left hippocampus, which is evidence of a prolonged and intense seizure event sufficient to infarct tissue. There is some edema in the uncus and amygdala also indicative of a prolonged seizure. The basis of the seizure, given the clinical history, is ethanol intoxication.
Lessons to be Learned
Seizure activity follows both the ischemic cascade and the glutamate cascade, but affects the hippocampus primarily and secondarily the limbic system, and is status epilepticus other portions of the brain. This distribution of injury is the result of seizure effect not on blood flow but affects on the voltage regulated channels. The hippocampi and limbic system also have higher concentration of glutamate dependent cells. Hence, these factors contribute to the distribution of post seizure injury.
In this case there is not only post seizure hippocampal edema, but also apparent tissue necrosis (activated glutamate cascade) in the mid hippocampal body.
In this case there is not only post seizure hippocampal edema, but also apparent tissue necrosis (activated glutamate cascade) in the mid hippocampal body.