Abstracts

Rationale: Status epilepticus (SE) is a neurological emergency with a complex pathophysiology, which is incompletely understood. Brain magnetic resonance imaging (MRI) changes due to SE often suggest a combination of cytotoxic and vasogenic edema, but there is limited information about the frequency and patterns of MRI abnormalities related to status epilepticus. The objective of this study was to characterize the MRI changes associated with SE. Methods: The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to May 2016 were derived from a prospective SE registry database. We reviewed records for demographics, medical history, and MRI changes attributable to seizures of all patients who had MRI during admission. Results: Forty (17.9%) of the 223 patients identified had MRI changes due to SE. Twenty (50%) of the patients with MRI changes had lesions restricted to the cerebral cortex (Frequently only disclosed on diffusion-weighted imaging and ipsilateral side of ictal focus). Twelve had remote signal abnormalities. Among them ipsilateral thalamus (n=8) and ipsilateral hippocampus (n=5) were the most frequently associated areas. Two had increased signal on T2 weighted images and variably restricted diffusion in the splenium. Five had marked vasogenic edema with contrast enhancement over ipsilateral cerebral cortical-subcortical area. Three had only diffusion-weighted imaging changes bordering an old encephaloclastic lesion. The classification of MRI change did not show association with clinical factors including seizure duration, EEG patterns, the status epilepticus severity score (STESS) and clinical outcome (Modified Rankin Scale score at discharge). Conclusions: MRI findings associated with SE were common and the pattern of MRI changes was various. These may occur with cytotoxic and/or vasogenic edema involving both cortical and subcortical structures. Owing to the wide spectrum of SE related MRI changes, increased awareness is needed for reducing of misdiagnosis. For elucidating their clinical significance, further study is needed. Funding: None.