Magnetic Resonance Signal Alterations in Epilepsy

Variable MR findings have been reported in the brain in the ictal or postictal stage [15-26]. These findings include transient increase in T2 signal and swelling of the cerebral cortex, subcortical white matter and medial temporal lobe (including hippocampus), thalamus, claustrum and cerebellar hemispheres (Figs.

Subcortical White Matter Lesions

Figure 8.4 a-e

Bilateral Cerebellar Hemispheres

Figure 8.4 a-e

Postictal cerebral lesion following generalized tonic-clonic seizure in a 42-year-old male with alcohol withdrawal. a T2-weighted image shows hyperintense lesions (arrows) in bilateral fronto-parietal cortex. b Tl-weighted image 8 days after the seizure shows gyriform high signal intensity in these lesions, representing cortical laminar necrosis (arrows). c Coronal gadolinium-enhanced Tl-weighted image shows gyriform enhancement of these lesions.d DW image shows corresponding regions of hyperintensity. e ADC map shows almost normal ADC values of these lesions,suggesting a subacute phase of ischemia

8.1,8.2,8.3,8.4,8.5,8.6 and 8.7). Cortical or subcortical lesions can be uni- or bilateral and they are predominantly found in the fronto-parietal regions. Whether periictal lesions are reversible or irreversible on MR imaging seems to depend on the duration and/or severity of the seizures.

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