On routine MR imaging, signal alterations related to ictal or postictal status can be misdiagnosed as infarctions, tumorous conditions, inflammatory diseases or demyelinating diseases. This may occur because routine MR sequences will not separate vasogenic edema from cytotoxic edema. Such misdiag-noses may result in unnecessary invasive treatment. Diffusion-weighted (DW) imaging is helpful in eval
Postictal cerebral lesion following partial seizure in a 64-year-old woman with generalized seizure secondary to hyperglycemia. a T2-weighted image 24 h after seizures shows hyperintense lesions in bilateral medial fronto-parietal cortex (arrows). b Coronal FLAIR image also shows cortical and subcortical hyperintense lesions (arrows). c Gadolinium-enhanced T1-weighted image shows no abnormal enhancement. d DW image shows these lesions as isointense with increased ADC (e) (arrows), representing vasogenic edema
Postictal cerebral lesion following partial seizures with or without secondary generalization in a 75-year-old woman. a T2-weighted image at 4 days after seizures shows hyperintense lesions in the right fronto-parietal region (arrow). b Coronal FLAIR image shows cortical and subcortical hyperintense lesions (arrows). c Gadolinium-enhanced Tl-weighted image shows a dense enhancing nodule (arrow) and leptomeningeal enhancement.d DW image shows these lesions as isointense to slightly hyperintense (arrows), with increased ADC (arrows) (e). Brain biopsy was performed and proved the lesions to be acute ischemic changes uating epilepsy, as it will detect cytotoxic edema and can differentiate between cytotoxic and vasogenic edema in ictal and postictal lesions of the brain.
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