Info Images Findings Impression Reco/Acuity Case Images View Images / Launch Visage Case Notes History 29 year old male with history of nocturnal "seizures" as a child. Now presents with an event with dyscognition and automtisms. Exam Coronal turbo spine-echo MR T2-w and axal MR flair sequences Prior Study CT Head and T1-w scans were not available. Dicom View Reference Material
Section 1 Submit Findings Case359de Findings Hippocampal Size & Symmetry There is evidence of acute post seizure change with increased hippocampal volume plus readily apparent T2-w positive edema (implying the seizure event is in either the hyperacute or early acute phase of evolution), or only minimally obvious implying the edema is recent, but not hyperacute. The area of involvement includes a significant portion of the hippocampus (more than just a small segment of one or both hippocampi). Yes No There is abnormal volume and T2-w signal increase is limited to the hilum of the hippocampus. Yes No There is abnormal volume and T2-w signal increase is limited to CA2. Yes No There is abnormal volume and T2-w signal increase is limited to CA1. Yes No There is abnormal volume and T2-w signal increase is limited to the subiculum. Yes No There is abnormal volume and T2-w signal increase is limited to the tail of the hippocampus. Yes No There is abnormally increased volume without apparent edema (implying the seizure evolutions is recent but not hyperacute) within the head/body/tail of hippocampus on one side or both sides. Yes No There is abnormal concurrent volume and signal within both hippocampi, and/or the entorhinal cortex, the parahippocampal gyrus, or other parts of the limbic system to suggest status epilepticus. Yes No There is abnormal reduced size or actual cavity formation in either hippocampus, usually with gliosis and loss of myelin signal; these are features of chronic hippocampal injury in epilepsy (i.e mesial temporal sclerosis or MTS). Yes No There is abnormal volume and asymmetry of the amygdala on either side (dysgenesis). Yes No There is evidence of a persistent hippocampal fissure remnants (variation of normal). Yes No Specific Hippocampal Details There is effacement of the internal hippocampal white matter pathways (i.e. ERC to dentate/CA2 tract, including the cisternal segment or hilar segment, and or Schaffer's collateral tract). Yes No There is effacement of the external hippocampal white matter pathways (i.e. alveus, fimbria, infrasubicular tract, or pararhinal tract) Yes No There is increased size and evidence of edema (increased T2 signal) in only a focal segment of either hippocampus. Yes No There is increased size and evidence of edema (increased T2 signal) in CA1. Yes No There is increased size and evidence of edema (increased T2 signal) in CA2. Yes No There is increased size and evidence of edema (increased T2 signal) in the hilum (containing the dentate granular layer, CA3, and CA4). Yes No There is increased size and evidence of edema (increased T2 signal) in the subiculum. Yes No There is increased size and evidence of edema (increased T2 signal) involving the entorhinal cortex , as well as the hippocampus. Yes No Brain Imaging for Foreign Tissue Lesion There is presence of an underlying hippocampal gray matter tumor: FTL ganglioglioma, DNET, or low grade glioma. Yes No There is presence of an intercurrent infiltrative mass (gliomatosis or CNS lymphoma) in the brain. Yes No There is presence of an intercurrent vascular malformation. Yes No There is presence of intercurrent blood products either new or chronic. Yes No There is presence of an intercurrent acute or subacute arterial/transcapillary/venous stroke. Yes No There is presence of intercurrent CNS infectious process (i.e encephalitis, pia arachnoid granulomatous disease, empyema, etc.). Yes No There is evidence of prior trauma including mesial temporal injury. Yes No Other Other significant findings are present. Yes No