MRI features of status epilepticus and their prognostic value
Abstract number :
2.409
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2021
Submission ID :
1886491
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Giorgi Kuchukhidze, MD, PhD - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg; Pilar Bosque Varela, MD - Neurology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Lukas Machegger, MD - Neuroradiology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Georg Zimmermann, PhD - Team Biostatistics and Big Medical Data, Intelligent Data Analytics Lab, Paracelsus Medical University of Salzburg, Austria; Andreas Oellerer, MSc - Neuroradiology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Jürgen Steinbacher, PhD - Neuroradiology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Mark McCoy, Prof. , MD - Neurology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Johannes Pfaff, Prof. , MD - Neuroradiology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria; Eugen Trinka, Prof. , MD - Neurology - Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria
Rationale: Status epilepticus (SE) is commonly associated with brain abnormalities on magnetic resonance imaging (MRI) - peri-ictal MRI alterations (PMA). PMA may be completely reversible, however, it is unclear, which factors are associated with a permanent brain damage and related clinical outcome. In this prospective study, we aimed to determine MRI features of SE and their prognostic value.
Methods: We prospectively recruited 27 patients (12 women; mean age 61y, range 19-88y) with electro-clinical diagnosis of SE. MRI was performed in the first 72 hours after the onset of SE. Patients with persisting PMA underwent follow-up MRI one week and one month following the onset of SE. Days spent in Intensive Care Unit (ICU), death in hospital and 30-day mortality were regarded as outcome measures.
Results: The following types of SE were diagnosed: Convulsive SE – (N=12); focal motor SE - (N=5); aphasic SE – (N=7); absence SE – (N=1); myoclonic SE in coma – (N=1); NCSE in coma – (N=1). In the two latter patients with SE in coma due to global cerebral hypoxia, it was difficult to differentiate if SE or hypoxia caused MRI abnormalities. In the other patients, peri-ictal MRI abnormalities (PMA) were seen in 40% (10/25). The median time from SE onset to MRI was 8 hours (range 0.25-71 h).
In 7/10 patients, PMA affected only cortex, in one patient the PMA was subcortical and in 2/10 patients, both cortical and subcortical structures were involved.
In the first MRI, the majority of patients with PMA had cerebral hyperperfusion in arterial spin labelling (ASL) - 80% (8/10) resolving on the first follow-up MRI in 88% (7/8) of patients. Diffusion restriction was seen in 60% (6/10) patients and signal increase in fluid attenuated inversion recovery (FLAIR) sequence – in 40% (4/10). They remained in most of the patients after one week following the SE onset: 67% (4/6) and 100% (4/4), respectively. Changes in all three MRI sequences (DWI, FLAIR and ASL) were observed in 4/10 patients. In these patients, PMA persisted on the first follow-up MRI. In the remaining six patients, PMA seen in only one MRI sequence (DWI – 2 or ASL – 4 patients) resumed completely on the first follow-up MRI. In three patients with persisting changes, the size of PMA was significantly reduced on the first follow-up MRI. In one patient, the first follow-up MRI showed unchanged PMA. PMA, however, disappeared in the second follow-up MRI in all patients. The representative example is in Figure1.
The mean number of days spent in ICU was higher in patients with PMA (1.30, SD 1.77) versus those without PMA (1.13, SD 1.68), not reaching, however, statistical significance in this small sample of patients. None of the patients with SE died in hospital or 30 days following the discharge from the hospital.
Conclusions: The most frequent PMA was hyperperfusion on ASL, which resumed in most of patients within one week. Persistence of PMA was associated with MRI changes in multiple sequences. Patients with PMA had longer stay at ICU as compared to those without PMA.
Funding: Please list any funding that was received in support of this abstract.: This study has been supported by FWF, Austrian Science Fund; Project number KLI 696.
Neuro Imaging