Hyperacute Seizure 06 - Clinical Case Summary
Hyperacute Seizure 06 - Clinical Case Summary
Hyperacute Seizure 06 - Clinical Case Summary
SummaryHistory
33 yo female with history of partial complex seizure, but now presents with a worse event (clinical status epilepticus) requiring intubation.
Exams Performed
T1-w MR post contrast only; MR Coronal T2-w spin echo and MR FLAIR; MR diffusion
Prior available imaging reports
CT Head was not obtained
T1-w MR post contrast only
1. There is enlargement of the hippocampi bilaterally. The changes involve all hippocampal subsegments.
2. There is no evidence of hyperemia to confirmthe dysautoregulation that can accompany with hyperacute seizures with status epilepticus (as evidenced in the clinical history).
3. The remainder of exam is within normal limits with no foreign tissue lesion, nor underlying brain malformation.
MR Coronal T2-w spin echo and MR FLAIR
1. There is evidence hyperacute changes in the hippocampi bilaterally. These findings were related to the clinical service on an emergent basis, since bilateral hippocampal changes can be associated with status epilepticus.
MR Diffusion (DWI)
1. There is evidence of bilateral hippocampal post seizure acute edema with T2 shine through on the DWI, but there is no positive ADC change to indicate completed tissue necrosis.
MR Susceptibility (SWI) was not obtained
T1-w MR post contrast only
1. There is enlargement of the hippocampi bilaterally. The changes involve all hippocampal subsegments.
2. There is no evidence of hyperemia to confirmthe dysautoregulation that can accompany with hyperacute seizures with status epilepticus (as evidenced in the clinical history).
3. The remainder of exam is within normal limits with no foreign tissue lesion, nor underlying brain malformation.
MR Coronal T2-w spin echo and MR FLAIR
1. There is evidence hyperacute changes in the hippocampi bilaterally. These findings were related to the clinical service on an emergent basis, since bilateral hippocampal changes can be associated with status epilepticus.
MR Diffusion (DWI)
1. There is evidence of bilateral hippocampal post seizure acute edema with T2 shine through on the DWI, but there is no positive ADC change to indicate completed tissue necrosis.
MR Susceptibility (SWI) was not obtained
Overall impression
1. There is a history of partial complex epilepsy, but the patient presents with a more severe seizure event than usual; it required intubation. MR reveals symmetric, post seizure cytogenic edema with complete effacement of the internal and external white matter tracts. This degree of concurrent advanced hippocampal edema is enough to diagnose hyperacute status epilepticus, which requires contacting the clinical service immediately. The MR diffusion was negative for restriction, but it may not be positive in the hyperacute timeframe.
Lessons to be Learned
Evidence of bilateral significant hippocampal edema in the absence of limbic system findings can be the presentation of status epilepticus. When observed, the clinical service needs to be informed immediately. Status epilepticus lasting more than 30 minutes will inevitably result in significant hippocampal and other brain damage.