UNILATERAL BRAIN OEDEMA RELATED TO FOCAL STATUS EPILEPTICUS
Abstract number :
1.239
Submission category :
5. Neuro Imaging
Year :
2014
Submission ID :
1867944
Source :
www.aesnet.org
Presentation date :
12/6/2014 12:00:00 AM
Published date :
Sep 29, 2014, 05:33 AM
Authors :
Noura Ali, Sudhir Kumar Palat Chirakkara, Jagan Mohan Reddy and shobhit sinha
Rationale: The peri-ictal neuroimaging changes related to status epilepticus can be both local (related to seizure discharge zone) and remote (in distant structure that may trans-synaptically connect to the discharge zone). However, unilateral panhemispheric cerebral edema with midline shift is an extremely rare presentation of focal status epilepticus and should be considered as a differential diagnosis in the appropriate clinical scenario. Methods: We present clinical and radiographic findings in a 38 years old female patient with baseline vegetative state following traumatic brain injury, who presented with prolonged right hemispheric status epilepticus. Results: The patient was in a vegetative state following prior traumatic brain injury. She also suffered from post-traumatic epilepsy that was controlled for years, and was seizure free off antiepileptic drugs (AED) for 1 year prior to her presentation. The patient presented with left sided focal motor seizures that gradually progressed in duration and frequency over 1 week. Her brain CT scan and MRI showed new right pancortical edema that was not present in previous imaging. In addition to that we also found contralateral cerebellar involvement, a very rare entity of remote peri-ictal changes called "crossed cerebellar diaschisis phenomena" (figure 1A). MRA of brain revealed dilated right Cerebral arteries representing ictal hyperperfusion resulting from the hypermetabolism and the breakdown of the blood brain barrier associated with seizure activity (figure 1B). EEG on presentation showed continuous seizure discharges over the right hemisphere (figure 2A). Metabolic and infectious etiologies for her focal status epilepticus has been excluded by normal laboratory metabolic panel and normal CSF studies Treatment of Status Epilepticus and optimizing the antiepileptic regimen with Benzodiazipines and Levertiracetam led to clinical and electrographic recovery (figure 2B) and patient was back to her baseline. Conclusions: Status epilepticus induced structural and radiological changes that may be related to excitotoxic, vasogenic and hypermetabolic response to continuous seizure activity are reversible if promptly recognized and treated. Our case with its rarity of neuroradiological findings serves as a reminder to consider focal status epilepticus as one of the differential diagnosis of unihemispheric brain edema.
Neuroimaging