癫痫发作后脑信号改变

来自：双语学影像；本期病例选自AJNR Case of the Week

Pedram Parva, MD；Clinical Instructor in Radiology；Harvard Medical School；VA Hospital and Healthcare System；Boston, MA

Description

A 35-year-old man with change in mental status following seizures

35岁男性，癫痫发作后精神异常。

Axial DWI:

T2 GRE:

axial FLAIR:

One-week follow-up T2-FLAIR:

Legends

Axial DWI (A), T2 GRE (B), and axial FLAIR (C) R sequences demonstrate bilateral symmetric hippocampal restricted diffusion with no signs of hemorrhage and associated increased T2 signal and mild swelling. One-week follow-up T2-weighted FLAIR MR sequence (D) demonstrates resolution of the T2W signal abnormality.

横断位DWI、T2 GRE、FLAIR序列示：双侧海马区对称性弥散受限，未见明显出血灶，T2WI见海马区轻度水肿、呈稍高信号。

1周后复查，T2-FLAIR序列示海马区异常信号消失。

Postictal Signal Changes

癫痫发作后脑信号改变

Key Diagnostic Features

• CT: transient focal decreased gyral or hippocampal attenuation

  CT:海马或脑回一过性密度减低。
  

• MRI: transient increased signal on FLAIR and T2WI (most common in the frontal and parietal lobes but also seen in the temporal and occipital lobes)

  MRI：T2WI及FLAIR一过性信号增高（常见于额、顶叶，也可见于颞叶和枕叶）
  

• Reversible diffusion restriction and abnormal cortical enhancement has been reported.

  有文献报道，病灶弥散受限，并可见皮层区异常强化。

• These findings presumably reflect postictal changes induced by seizure.

  这些表现可能与癫痫发作后的改变有关。

DDx

• Limbic encephalitis

  边缘性脑炎

• Hypoglycemia and other toxic-metabolic etiologies

  低血糖或其他毒性-代谢性病变

• Heat stroke

  中暑

• Ischemia, including transient global amnesia

  局部缺血，包括一过性完全遗忘症

• Venous sinus thrombosis

  静脉窦血栓形成

Rx

Medical management according to seizures etiology

针对癫痫病因药物治疗

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