Hyperacute Seizure 11 - Clinical Case Summary
Hyperacute Seizure 11 - Clinical Case Summary
Hyperacute Seizure 11 - Clinical Case Summary
SummaryHistory
32 yo male presenting with episode of staring and unresponsiveness. His head turned to the right and then he fell.
Exams Performed
MR T1-w pre and post contrast; MR Coronal T2-w spin echo and MR FLAIR; MR diffusion
Prior available imaging reports
CT Head was not available.
MR T1-w exam pre and post contrast
1. There developmental heterotopic gray matter in the posterior right frontal lobe.
2. Abnormal left hippocampus with evidence of post seizure hyperacute changes involving all portions of the left hippocampus.
3. There is abnormal contrast enhancement centered in the transition zone between the body and tail on the right. This could represent acute post seizure dysautoregulation, or could represent tissue necrosis; the differentiation is indeterminate based only on the post contrast T1-w sequence; correlate with the MR diffusion for evidence of water restriction.
T2-w MR
1. There is evidence of hyperacute post seizure left hippocampal edema involving all subsegments of left hippocampal segments. The right hippocampus appears normal.
2. There is developamental heterotopic posterior frontal gray matter and focal left parietal atrophy with left ventricular trigone dilatation and adjcent deep parietal leukomalacia.
MR diffusion (DWI)
1. The MR diffusion demonstrates T2-w shine-through from signal increase in the the left hippocampus. There is no evidence of water restriction in the body-tail transition zone to suggest initiated glutamate cascade; this is the site of abnormal contrast enhancement on the post contrast T1-w sequence. As an aside, the followup MR one year later demonstrated return to normal MR apearance of the left hippocampus, and no focal tissue loss in the site of abnormal contrast enhancement.
MR Susceptibility (SWI) is not available
MR T1-w exam pre and post contrast
1. There developmental heterotopic gray matter in the posterior right frontal lobe.
2. Abnormal left hippocampus with evidence of post seizure hyperacute changes involving all portions of the left hippocampus.
3. There is abnormal contrast enhancement centered in the transition zone between the body and tail on the right. This could represent acute post seizure dysautoregulation, or could represent tissue necrosis; the differentiation is indeterminate based only on the post contrast T1-w sequence; correlate with the MR diffusion for evidence of water restriction.
T2-w MR
1. There is evidence of hyperacute post seizure left hippocampal edema involving all subsegments of left hippocampal segments. The right hippocampus appears normal.
2. There is developamental heterotopic posterior frontal gray matter and focal left parietal atrophy with left ventricular trigone dilatation and adjcent deep parietal leukomalacia.
MR diffusion (DWI)
1. The MR diffusion demonstrates T2-w shine-through from signal increase in the the left hippocampus. There is no evidence of water restriction in the body-tail transition zone to suggest initiated glutamate cascade; this is the site of abnormal contrast enhancement on the post contrast T1-w sequence. As an aside, the followup MR one year later demonstrated return to normal MR apearance of the left hippocampus, and no focal tissue loss in the site of abnormal contrast enhancement.
MR Susceptibility (SWI) is not available
Overall impression
1. In this case there is evidence of a foreign tissue lesion (FTL) with developmental migrational abnormality resulting in subependymal gray matter heterotopia adjacent to the body of the right lateral ventricle. However, despite the FTL being on the right, the recent seizure has produced left sided hippocampal changes consistent with a hyperacute seizure event. There is diffuse hippocampal edema and effacement of white matter tracts in the head body and tail. The right hippocampus is normal.