Magnetic Resonance Imaging of Epilepsy

Magnetic resonance imaging is widely used to evaluate patients with seizures and can detect structural brain abnormalities that may give rise to the epileptic disorder, e.g. stroke, anoxic injury, trauma, tumor, infections, demyelination and congenital anomalies. The most common cause of seizures in patients older than 45 years is stroke [7].Intracranial tumors are often associated with epileptic seizures, and trauma is the most common cause of seizures in patients aged 15-24 years [8].Up to 5% of epilepsy cases have a history of central nervous system infections [9].

Magnetic resonance imaging has become very useful for the diagnosis of an important cause of

Postictal Seizure
Figure 8.1 a-d

Postictal cerebral lesion following partial seizure evolving to generalized seizure in a 60-year-old woman. a T2-weighted and b FLAIR images 24 h after seizures show hyperintense lesions (arrows) in the right fonto-parietal cortex. c DW image and d ADC map show these lesions as isointense, probably representing mild vasogenic edema. These lesions were resolved on the 20-day follow-up MRI (not shown)

seizure, namely mesial temporal (hippocampal) sclerosis [10-14]. Most seizure activity resolves within a few minutes without persistent neurologic deficits. However, transient hemiparesis (Todd's paralysis), sensory loss, persistent altered mental status, or aphasia occasionally occurs in epilepsy. MR imaging can show secondary effects of seizures on the brain [15-26]. For example, mesial temporal sclerosis, which may occur as a primary lesion, may also arise as a lesion secondary to status epilepticus [19,21].

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