Abstracts

RATIONALE: MR changes occur in both status epilepticus (SE) and limbic encephalitis (LE). We describe acute and chronic imaging findings in a patient who presented with SE and LE. METHODS: A 28-year-old woman with no significant past medical history presented with four days of bizarre behavior, paranoid delusions, and headache. Subsequently, she developed fever, and became obtunded. CSF showed lymphocytic pleocytosis, elevated protein, and normal glucose. EEG monitoring showed non-convulsive status epilepticus. Initial MR evaluation showed isolated hippocampal T2 signal hyperintensity bilaterally. Extensive workup, including cultures, anti-neuronal antibodies, and investigations for underlying neoplasm, resulted in no diagnosis of the underlying etiology of her encephalitis. With treatment, she gradually improved over six weeks after her initial presentation. After performing a volumetric MRI at nine months after symptom onset, we then performed deformation-based hippocampal surface segmentation and compared changes with a normal hippocampal surface segmentation. RESULTS: Nine months after intial presentation, the left hippocampal volume was 959 mm3 and the right hippocampal volume was 925 mm3. The figure shows the deformation segmentation of hippocampi. Visual comparison with the normal hippocampi showed global changes in hippocampal shape. CONCLUSIONS: This case shows resultant structural hippocampal changes after an episode of SE and LE. Because SE may have contributed to the resultant structural changes, this case helps to emphasize early treatment of this condition.