Refractory focal epilepsy: findings by MRI.
|
|
- Marlene Welch
- 6 years ago
- Views:
Transcription
1 Refractory focal epilepsy: findings by MRI. Doctors Nicolás Sgarbi, Osmar Telis Clinical Radiology Department Hospital de Clínicas Montevideo- Uruguay ABSTRACT Epilepsy is one of the most frequent neurological diseases, being one of the most common reasons MRIs are requested in our environment. Although an adequate control of the disease is achieved with most patients, close to 30 % do not achieve an adequate therapeutic response, developing so called refractory epilepsy. The possibility of finding a focal lesion responsible for the clinical picture increases significantly in patients with refractory epilepsy, which gives great importance to this imaging study. In this article we show findings in a group of patients with refractory epilepsy studied within the epilepsy program in our center, highlighting the contributions of MRI and the importance of an adequate study protocol. Key words: refractory epilepsy, temporomesial sclerosis, cortical malformations, MRI. INTRODUCTION Epilepsy is the second most frequent neurological disease and MRI is the chosen diagnostic method for this pathology. It is estimated that approximately 8% of the population will suffer at least one critical episode during its life with the health impact this entails (1). Correct classifying of the crisis and the clinical picture is crucial to establish the etiological diagnosis precisely and the according treatment which substantially impacts the patient s prognosis (1). Although most patients are able to control the disease with medical treatment, approximately 30% do not respond to the same with the resulting increase in morbimortality and with the ORIGINAL ARTICLE E II/Vol. XV/Num. 2/ Jun 2012
2 Refractory focal epilepsy: findings by MRI. high costs this represents for the health system (2, 3). Diagnostic and therapeutic algorithms in this group of patients differ substantially, the contributions of MRI being essential due to greater probabilities of identifying an anatomical substrate (3). The objective of our work is to carry out an iconographic trial with the findings by MRI in a group of patients with refractory epilepsy, systematizing and organizing hierarchically the most frequent alterations. The main signs in conventional and high resolution are highlighted and in some cases the usefulness and contributions of spectroscopy are highlighted. MATERIALS AND METHOD A series of patients with refractory epilepsy were analyzed retrospectively. These patients were sent to our Service for assessment within the Epilepsy Program. The total of patients studied in one year (June 2010 till July 2011) due to epilepsy was of 375 and of them 43 (11,5%) with the clinical reference data of refractory epilepsy, all with partial epilepsy. In all of them the institutional protocol of imaging assessment by MRI was performed using closed field unit, 1,5 T potency which includes as routine: a high resolution volumetric 3D sequence T1- weighted (MPRAGE), at Figure 1: left temporo mesial sclerosis. Patient with a history of temporal epilepsy. Using coronal FLAIR sequence (A), an increase in the intensity of the signal is observed in the temporo mesial region on the left side, with conserved anatomic structure (B) also visualized in the corresponding IR high resolution sequence. In FSE T2 coronal sequence (C) in a more posterior position, one of the secondary signs is observed, namely, less development of the posterior pillar of the trigone of the same side.
3 least one sequence T2- weighted, preferably in the coronal plane, FLAIR sequences and diffusion in the axial plane and specific sequences to study FLAIR and STIR hyppocampus with fine cuts 2mm in maximum thickness. In some patients we also counted with sequences with paramagnetic i.v. contrast based on gadolinium salts and in specific cases spectroscopic sequence with PRESS and CSI technique, TE 40 and 135 ms in the area of interest. In patients with vascular malformations, as we will later see we included and analyzed the contributions of gradient echo sequences (GRE T2*) or magnetic susceptibility (SWI) and of arterial or venous MRA with time of flight protocol TOF. RESULTS Of the selected 43 patients, 23 are of feminine sex and 20 of masculine sex, all over 14 years of age, their ages ranging from 14 to 47 years. In this group of patients the MRI performed in our Service was to control lesions or images already known and the study was part of the routine protocol for structural evaluation with the aim of including it or not in the epilepsy surgery program. All patients were catalogued as bearers of refractory partial epilepsy according to the criteria established by ILAE (2). Within the structural anomalies found we should highlight that in 27 of the 43 patients studied the topography of the lesions was temporal, concordant in every case with the clinical profile of the crisis. Figure 2: cortical focal dysplasia. Patient with partial simple motor crisis of right hemibody which presents in high resolution T2 sequence (A) a pathological cortical frontal left area, with increased signal I FLAIR (B), drawing a tract which is directed towards the lateral ventricle, located in depth. ORIGINAL ARTICLE E II/Vol. XV/Num. 2/ Jun 2012
4 Refractory focal epilepsy: findings by MRI. For didactic and illustrative purposes we will systematize the patients in the following groups (Table 1): patients without TMS 2 had a history of temporal epilepsy, both with a final diagnosis of cortical dysplasia. Alterations in development and congenital disorders (23). b.- Vascular malformations. Vascular malformations (8). Tumoral lesions (6). Miscellaneous (6). a.- Alterations in development and congenital disorders. This group is formed by different entities. The main group was formed by 13 patients bearing temporal epilepsy who were diagnosed as having temporomesial sclerosis (STM). (Figure 1). The remaining patients had different alterations in development: cortical dysplasias (Figure 2) (4 patients), grey matter heterotopias (3 cases), schizencephaly (1 case) and 2 patients with polymicrogyria. All these patients had a history of epilepsy since childhood. Of the Within this group 3 types of pathologies were found: aneurisms (1 case), cavernous angiomas ( 4 cases) and arterio- venous (3 cases). Within this group it was found one patient bearing an aneurism, in 2 patients with cavernous angiomas and in one of the patients an arterio- venous malformation localization of the lesion coincided with the clinic (temporal epilepsy). In all cases diagnosis was established by MRI which was confirmed in the cases of the aneurism and MAV by direct angiographic methods. In the case of patients with cavernous angiomas diagnosis was confirmed after surgery by pathologic anatomic study of the piece. (Figure 3). In patients with aneurisms or MAV conventional sequences showed typical findings added to the contributions of the sequences of the MRA. C.- Tumoral lesions. In this group of patients the lesions found were all primary neoplasias of the nervous system and low grade of the OMS. In all cases an MRI established the correct diagnosis of neoplasia, confirmed by the metabolic findings of the spectroscopy performed.
5 The tumor grade was also established, which coincided in every case with the final anatomo- pathological study. Of the 6 patients with tumoral lesions 2 corresponded to fibrillary astrocytomas (OMS grade II ), 1 case was a pilocytic astrocytoma ( OMS grade I), 1 neuro epithelial dysembrioplastic tumor (DNET) and in 2 cases it was gangliogliomas. Of the total lesions in this group, 4 were of temporal localization. (Figure 4). perinatal background related to the lesion found. In 3 of these patients localization of the sequelae area was temporal. One patient presented a lesion of the hypophiseal stem with diagnosis of probable hypothalamic hamartoma by stereotactic biopsy. The remaining patient presented epilepsy which had started recently and 6 months of evolution, refractory to all established medical treatment and which showed a large pathological area Figure 3: anterior right cavernous temporo mesial angioma. Typical image with high signal in T1 ( A ) areas due to the presence of hemoglobin in different stages, with artifice of magnetic susceptibility in GRE T2* (B) and classic popcorn aspect as seen in high resolution sequence IR (C). d.- Miscellaneous. In this group of patients, 6 in total, 4 patients were found with sequelae areas and gliosis, 3 of which were epileptic since infancy and with which the biopsy study showed to correspond to sub acute encephalitis. (Figure 5). DISCUSSION Epilepsy is a highly frequent neurological disease, MRI is the ORIGINAL ARTICLE E II/Vol. XV/Num. 2/ Jun 2012
6 Refractory focal epilepsy: findings by MRI. Figure 4: Ganglioglioma. Patient who presents a tumoral lesion located in the posterior sector of the temporo mesial region on the left side, heterogeneous with high signal cystic sectors in T2 (A), low signal in T1 (B) and without evidence of significant edema nor enhancement in sequence with i.v. contrast ( C ). method of reference to evaluate affected patients. The ways it manifests are very varied and there is a consensus on the definition and way of classifying the different syndromes it may present (1). Focal forms are the ones which most frequently present an anatomic structural substrate, which can be identified with different study techniques. This group of patients may be refractory to medical treatment and the structural study of the nervous system is of particular interest in order to identify an epileptogenic focus and evaluate the possibility of surgical treatment. When performing an MRI study on these patients it is vital to count with the largest array of clinical and physiological information possible, which definitely increases the sensitivity of the method to identify structural anomalies or lesions which are the cause of the disease. This has been particularly proven in the case of patients with focal and temporal epilepsy, in which the percentage of pathological studies increases notably when the patients are referred with the clinical categorization of temporal epilepsy and lateralization of focus. Using high resolution sequences is indispensable since they significantly increase global performance of the method. That is why generic protocols, not destined to the study of deep regions, such as the temporal lobule, pass by a significant percentage of lesions.
7 CONCLUSIONS In our series, all patients were bearers of focal epilepsy and most of them (62,7%) of temporal localization, which coincided in all cases with localization of the anomaly or lesion found. Furthermore, 41 out of 43 patients presented the alterations most frequently found in adult patients as being responsible for refractory focal epilepsy according to the consulted literature. A point to highlight in this small series is that all the patients referred as bearers of refractory epilepsy presented anomalies diagnosed by MRI, there weren t no cases of negative MRI and other methods which established the diagnosis. It is vital to know the wide spectrum of alterations, which can be the cause of functional alterations in the patient with refractory focal epilepsy, correct anatomic and structural analysis of the encephalus and its different areas is of great importance. MRI protocols used must be directed towards clinical suspicion, type of epilepsy and performed with all the available physiological information, which allows carrying out a detailed analysis of the encephalic region, probably pathological. Taking into account the multiple diagnostic possibilities and carrying out a detailed analysis of the signs found, a positive diagnosis may be established in most cases with good levels of sensitivity and specificity. A B C Figure 5: sub acute encephalitis. Patient with final diagnosis of sub acute encephalitis by surgical biopsy of temporal lobule on the left side. In FLAIR (A) a large area with edema is observed, with effect of mass with high signal in diffusion ( B ) and without enhancement with i.v. contrast (C). ORIGINAL ARTICLE E II/Vol. XV/Num. 2/ Jun 2012
8 Refractory focal epilepsy: findings by MRI. BIBLIOGRAPHY 1. Karis JP. Epilepsy. ACR Appropiatness criteria. AJNR 2008; 29: Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission ontherapeutic Strategies. Epilepsia 2010; 51(6): Beleza P. Refractory epilepsy : a clinically oriented review. Eur Neurol 2009; 62: López JI, Pomposo-Gaztelu I. Patología quirúrgica de la epilepsia. Rev Neurol 2010; 50: Wehner T, Lüders H. Role of neuroimaging in the presurgical evaluation of epilepsy. J Clin Neuro l2008; 4(1): Vattipally VR, Bronen RA. MR imaging of epilepsy: strategies forsuccessful interpretation. Neuroimag Clin N Am 2004;14:
SWI including phase and magnitude images
On-line Table: MRI imaging recommendation and summary of key features Sequence Pathologies Visible Key Features T1 volumetric high-resolution whole-brain reformatted in axial, coronal, and sagittal planes
More informationImaging for Epilepsy Diagnosis December 2, 2011
Imaging for Epilepsy Diagnosis December 2, 2011 Samuel Wiebe, MD University of Calgary Canada American Epilepsy Society Annual Meeting Disclosure University of Calgary Hopewell Professorship of Clinical
More informationMagnetic Resonance Imaging. Basics of MRI in practice. Generation of MR signal. Generation of MR signal. Spin echo imaging. Generation of MR signal
Magnetic Resonance Imaging Protons aligned with B0 magnetic filed Longitudinal magnetization - T1 relaxation Transverse magnetization - T2 relaxation Signal measured in the transverse plane Basics of MRI
More informationHamartomas and epilepsy: clinical and imaging characteristics
Seizure 2003; 12: 307 311 doi:10.1016/s1059 1311(02)00272-8 Hamartomas and epilepsy: clinical and imaging characteristics B. DIEHL, R. PRAYSON, I. NAJM & P. RUGGIERI Departments of Neurology, Pathology
More informationPharmacoresistant temporal lobe epilepsy - a diagnostic performance of standardized MRI protocol in detection of epileptogenic lesion
Pharmacoresistant temporal lobe epilepsy - a diagnostic performance of standardized MRI protocol in detection of epileptogenic lesion Poster No.: C-2226 Congress: ECR 2013 Type: Scientific Exhibit Authors:
More informationImaging of Pediatric Epilepsy MRI. Epilepsy: Nonacute Situation
Imaging of Pediatric Epilepsy Epilepsy: Nonacute Situation MR is the study of choice Tailor MR study to suspected epileptogenic zone Temporal lobe Extratemporal A. James Barkovich, MD University of California
More informationAn analysis of MRI findings in patients referred with fits
An analysis of MRI findings in patients referred with fits Pallewatte AS 1, Alahakoon S 1, Senanayake G 1, Bulathsinghela BC 1 1 National Hospital of Sri Lanka, Colombo, Sri Lanka Abstract Introduction:
More informationPearls and Pitfalls in Neuroradiology of Cerebrovascular Disease The Essentials with MR and CT
Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease The Essentials with MR and CT Val M. Runge, MD Wendy R. K. Smoker, MD Anton Valavanis, MD Control # 823 Purpose The focus of this educational
More informationThe Changing Surgical Landscape in Kids
The Changing Surgical Landscape in Kids December 7, 2013 Howard L. Weiner, MD NYU Langone Medical Center American Epilepsy Society Annual Meeting Disclosure none American Epilepsy Society 2013 Annual Meeting
More information3T MRI imaging approach to pediatric epileptic seizures:
3T MRI imaging approach to pediatric epileptic seizures: Poster No.: C-1886 Congress: ECR 2016 Type: Educational Exhibit Authors: J. S. Alaín, E. M. DE LUCAS, J. C. Quintero Rivera, C. Pérez 1 2 3 3 3
More informationDr H. Gharebaghian MD Neurologist Department of Neurology Kermanshah Faculty of Medicine
Dr H. Gharebaghian MD Neurologist Department of Neurology Kermanshah Faculty of Medicine Definitions Seizures are transient events that include symptoms and/or signs of abnormal excessive hypersynchronous
More informationPRESURGICAL EVALUATION. ISLAND OF COS Hippocrates: On the Sacred Disease. Disclosure Research-Educational Grants. Patients with seizure disorders
PRESURGICAL EVALUATION Patients with seizure disorders Gregory D. Cascino, MD Mayo Clinic Disclosure Research-Educational Grants Mayo Foundation Neuro Pace, Inc. American Epilepsy Society American Academy
More informationMagnetic Resonance Imaging of the Brain in Adults Presenting With New Onset Seizures Pannag Desai K N 1, Ravi N 2
Magnetic Resonance Imaging of the Brain in Adults Presenting With New Onset Seizures Pannag Desai K N 1, Ravi N 2 1 (Department of Radiodiagnosis, BMC&RI, India) 2 (Department of Radiodiagnosis, BMC&RI,
More informationWhat is the Relationship Between Arachnoid Cysts and Seizure Foci?
Epilepsin, 38( 10):1098-1102, 1997 Lippincott-Raven Publishers, Philadelphia 0 International League Against Epilepsy What is the Relationship Between Arachnoid Cysts and Seizure Foci? Santiago Arroyo and
More informationImaging in Epilepsy. Nucharin Supakul, MD Ramathibodi Hospital, Mahidol University August 22, 2015
Imaging in Epilepsy Nucharin Supakul, MD Ramathibodi Hospital, Mahidol University August 22, 2015 Nothing to disclose Outline Role of Imaging and pitfalls Imaging protocol Case scenarios Clinical & Electrophysiologic
More informationConsortium of MS Centres Guidelines Revised Standardized MRI Protocol. for the Diagnosis and Follow-up of MS. David K.B.
Consortium of MS Centres Guidelines Revised Standardized MRI Protocol for the Diagnosis and Follow-up of MS David K.B. Li MD FRCPC Indianapolis, Indiana May 27, 2015 Disclosure I have received research
More informationInvasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES. Mr. Johnson. Seizures at 29 Years of Age. Dileep Nair, MD Juan Bulacio, MD
Invasive Evaluation for Epilepsy Surgery Lesional Cases NO DISCLOSURES Dileep Nair, MD Juan Bulacio, MD Mr. Johnson Seizures at 29 Years of Age Onset of seizures at 16 years of age bed wetting episodes
More informationFocal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report
Clinical commentary Epileptic Disord 2014; 16 (3): 370-4 Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report Myo Khaing 1,2, Kheng-Seang Lim 1, Chong-Tin Tan 1
More informationStandard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy
PAPER Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy J von Oertzen, H Urbach, S Jungbluth, M Kurthen, M Reuber, G Fernández, C E Elger... See Editorial Commentary
More informationStructural and functional imaging for the characterization of CNS lymphomas
Structural and functional imaging for the characterization of CNS lymphomas Cristina Besada Introduction A few decades ago, Primary Central Nervous System Lymphoma (PCNSL) was considered as an extremely
More informationAdvanced multimodal imaging in malformations of cortical development
Advanced multimodal imaging in malformations of cortical development Seok Jun Hong (sjhong@bic.mni.mcgill.ca) NOEL Neuroimaging of Epilepsy Lab MICA Multimodal Imaging and Connectome Analysis Lab w4 w5
More informationMultimodal Imaging in Extratemporal Epilepsy Surgery
Open Access Case Report DOI: 10.7759/cureus.2338 Multimodal Imaging in Extratemporal Epilepsy Surgery Christian Vollmar 1, Aurelia Peraud 2, Soheyl Noachtar 1 1. Epilepsy Center, Dept. of Neurology, University
More information9/30/2016. Advances in Epilepsy Surgery. Epidemiology. Epidemiology
Advances in Epilepsy Surgery George Jallo, M.D. Director, Institute for Brain Protection Sciences Johns Hopkins All Children s Hospital St Petersburg, Florida Epidemiology WHO lists it as the second most
More informationNeuroimaging in pediatric seizures
International Journal of Research in Medical Sciences Sahdev R et al. Int J Res Med Sci. 2017 Jan;5(1):295-299 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164566
More informationEPILEPSY. New Ideas about an Old Disease. Gregory D. Cascino, MD
EPILEPSY New Ideas about an Old Disease Gregory D. Cascino, MD Disclosure Research-Educational Grants Neuro Pace, Inc. American Epilepsy Society American Academy of Neurology Neurology (Associate Editor)
More informationCase #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010
Difficult Diagnosis Pediatrics Joseph E. Sullivan M.D. Assistant Professor of Clinical Neurology & Pediatrics Director, UCSF Pediatric Epilepsy Center University of California San Francisco Case #1 15
More informationCerebral MRI as an important diagnostic tool in temporal lobe epilepsy
Cerebral MRI as an important diagnostic tool in temporal lobe epilepsy Poster No.: C-2190 Congress: ECR 2014 Type: Educational Exhibit Authors: A. Puiu, D. Negru; Iasi/RO Keywords: Neuroradiology brain,
More informationESOR COURSES FOR EDiR 2018
ESOR COURSES FOR EDiR 2018 Education in partnership ESOR Courses for EDiR ESOR Courses for EDiR Course information In 2018, ESOR is continuing to organise foundation courses to prepare/assist those entering
More informationAdvanced MR Imaging of Cortical Dysplasia with or without Neoplasm: A Report of Two Cases
AJNR Am J Neuroradiol 23:1686 1691, November/December 2002 Case Report Advanced MR Imaging of Cortical Dysplasia with or without Neoplasm: A Report of Two Cases Jay J. Pillai, Richard B. Hessler, Jerry
More informationNeuroradiology MR Protocols
Neuroradiology MR Protocols Brain protocols N 1: Brain MRI without contrast N 2: Pre- and post-contrast brain MRI N 3 is deleted N 4: Brain MRI without or pre-/post-contrast (seizure protocol) N 5: Pre-
More informationHigh spatial resolution reveals excellent detail in pediatric neuro imaging
Publication for the Philips MRI Community Issue 46 2012/2 High spatial resolution reveals excellent detail in pediatric neuro imaging Achieva 3.0T with 32-channel SENSE Head coil has become the system
More informationEssentials of Clinical MR, 2 nd edition. 99. MRA Principles and Carotid MRA
99. MRA Principles and Carotid MRA As described in Chapter 12, time of flight (TOF) magnetic resonance angiography (MRA) is commonly utilized in the evaluation of the circle of Willis. TOF MRA allows depiction
More informationMagnetic resonance imaging findings and Spectrum of Etiologies in children epilepsy
Magnetic resonance imaging findings and Spectrum of Etiologies in children epilepsy Poster No.: C-2262 Congress: ECR 2015 Type: Educational Exhibit Authors: B. Alami, L. Tazi, Z. Traoré, M. Y. Alaoui Lamrani,
More informationIndex. aneurysm, 92 carotid occlusion, 94 ICA stenosis, 95 intracranial, 92 MCA, 94
A ADC. See Apparent diffusion coefficient (ADC) Aneurysm cerebral artery aneurysm, 93 CT scan, 93 gadolinium, 93 Angiography, 13 Anoxic brain injury, 25 Apparent diffusion coefficient (ADC), 7 Arachnoid
More informationAnalysis between clinical and MRI findings of childhood and teenages with epilepsy after hypoxic-ischemic encephalopathy in neonates periods
Analysis between clinical and MRI findings of childhood and teenages with epilepsy after hypoxic-ischemic encephalopathy in neonates periods Poster No.: C-0401 Congress: ECR 2015 Type: Scientific Exhibit
More informationEpilepsy & Behavior Case Reports
Epilepsy & Behavior Case Reports 1 (2013) 45 49 Contents lists available at ScienceDirect Epilepsy & Behavior Case Reports journal homepage: www.elsevier.com/locate/ebcr Case Report Partial disconnection
More informationNeuroradiological, clinical and genetic characterization of new forms of hereditary leukoencephalopathies
Neuroradiological, clinical and genetic characterization of new forms of hereditary leukoencephalopathies Principal Investigator: Dr. Donatella Tampieri, MD, FRCPC, Department of Neuroradiology, Montreal
More informationEpilepsy, a common chronic neurological disorder, is a
10 SUPPLEMENT TO Journal of the association of physicians of india august 2013 VOL. 61 Epilepsy: Diagnostic Evaluation JMK Murthy* Epilepsy, a common chronic neurological disorder, is a potentially treatable
More informationMagnetic Resonance Angiography
Magnetic Resonance Angiography 1 Magnetic Resonance Angiography exploits flow enhancement of GR sequences saturation of venous flow allows arterial visualization saturation of arterial flow allows venous
More informationLaura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University
Laura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University Disclosures! No conflicts of interest to disclose Neuroimaging 101! Plain films! Computed tomography " Angiography " Perfusion! Magnetic
More informationThe American Approach to Depth Electrode Insertion December 4, 2012
The American Approach to Depth Electrode Insertion December 4, 2012 Jonathan Miller, MD Director, Epilepsy Surgery University Hospitals Case Medical Center/Case Western Reserve University Cleveland, Ohio
More informationCT & MRI Evaluation of Brain Tumour & Tumour like Conditions
CT & MRI Evaluation of Brain Tumour & Tumour like Conditions Dr. Anjana Trivedi 1, Dr. Jay Thakkar 2, Dr. Maulik Jethva 3, Dr. Ishita Virda 4 1 M.D. Radiology, Professor and Head, P.D.U. Medical College
More informationSupratentorial multiple little meningiomas with transitory stroke symptoms like. MRI case presentation
114 Romanian Neurosurgery (2010) XVII 1: 114-121 Supratentorial multiple little meningiomas with transitory stroke symptoms like. MRI case presentation E. Moldovanu 1,2, Adriana Moldovanu 1,2, Carmen Gherman
More informationNeuroimaging in Investigation of Patients With Epilepsy Fernando Cendes, MD, PhD
Review Article Neuroimaging in Investigation of Patients With Epilepsy Fernando Cendes, MD, PhD ABSTRACT Purpose of Review: This review discusses the MRI and functional imaging findings in patients with
More informationMasses of the Corpus Callosum
Masses of the Corpus Callosum Kesav Raghavan, HMS Year III Dr. Agenda Corpus Callosum Development and Anatomy Our Patient: Clinical Presentation Differential Diagnosis of Masses in the Corpus Callosum
More informationCASE OF THE WEEK PROFESSOR YASSER METWALLY
CASE OF THE WEEK PROFESSOR YASSER METWALLY CLINICAL PICTURE CLINICAL PICTURE: CLINICAL PICTURE: A 6 years old male patient presented clinically with intractable complex partial seizure. The child is mentally
More informationSpeed, Comfort and Quality with NeuroDrive
Speed, Comfort and Quality with NeuroDrive Echelon Oval provides a broad range of capabilities supporting fast, accurate diagnosis of brain conditions and injuries. From anatomical depiction to vascular
More informationJMSCR Vol 04 Issue 12 Page December 2016
www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v4i12.113 Role of Computed Tomography in Evaluation
More informationCase reports functional imaging in epilepsy
Seizure 2001; 10: 157 161 doi:10.1053/seiz.2001.0552, available online at http://www.idealibrary.com on Case reports functional imaging in epilepsy MARK P. RICHARDSON Medical Research Council Fellow, Institute
More informationJ Neurol Neurosurg Psychiatry 2005; 76(Suppl III):iii2 iii10. doi: /jnnp RAY COMPUTED TOMOGRAPHY
iii2 See end of article for authors affiliations Correspondence to: Professor John S Duncan, Department of Clinical and Experimental Epilepsy, Institute of Neurology, Queen Square, University College London,
More informationAttenuation value in HU From -500 To HU From -10 To HU From 60 To 90 HU. From 200 HU and above
Brain Imaging Common CT attenuation values Structure Air Fat Water Brain tissue Recent hematoma Calcifications Bone Brain edema and infarction Normal liver parenchyma Attenuation value in HU From -500
More informationMR Advance Techniques. Vascular Imaging. Class II
MR Advance Techniques Vascular Imaging Class II 1 Vascular Imaging There are several methods that can be used to evaluate the cardiovascular systems with the use of MRI. MRI will aloud to evaluate morphology
More informationSeizure remission in adults with long-standing intractable epilepsy: An extended follow-up
Epilepsy Research (2010) xxx, xxx xxx journal homepage: www.elsevier.com/locate/epilepsyres Seizure remission in adults with long-standing intractable epilepsy: An extended follow-up Hyunmi Choi a,, Gary
More informationHigh Resolution Ictal SPECT: Enhanced Epileptic Source Targeting?
High Resolution Ictal SPECT: Enhanced Epileptic Source Targeting? Marvin A Rossi MD, PhD RUSH Epilepsy Center Research Lab http://www.synapticom.net Chicago, IL USA Medically-Refractory Epilepsy 500,000-800,000
More informationSemiological seizure classification of epileptic seizures in children admitted to video-eeg monitoring unit
The Turkish Journal of Pediatrics 2015; 57: 317-323 Original Semiological seizure classification of epileptic seizures in children admitted to video-eeg monitoring unit Serdar Alan 1*, Dilek Yalnızoğlu
More informationRole of magnetic resonance imaging for preoperative evaluation of patients with refractory epilepsy
ACF Hui JMK Lam YL Chan KM Au-Yeung KS Wong R Kay WS Poon Key words: Epilepsy; Magnetic resonance imaging; Surgery "# Hong Kong Med J 2003;9:20-4 The Chinese University of Hong Kong, Prince of Wales Hospital,
More informationGeneral Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27
General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year
More informationUniversity of Michigan continues fine-tuning neuro ExamCards
I s s u e 3 1 - M a rc h 2 0 0 7 F i e l d Strength Publication for the Philips MRI Community University of Michigan continues fine-tuning neuro ExamCards Drs. Mukherji, Parmar create Achieva 3.0T ExamCards
More informationUnusual Findings in Brain Biopsies of Two Patients with Acute Magnetic Resonance Imaging Lesions Associated with Focal Seizures
Epilepsia, 46(9):1495 1501, 2005 Blackwell Publishing, Inc. C 2005 International League Against Epilepsy Unusual Findings in Brain Biopsies of Two Patients with Acute Magnetic Resonance Imaging Lesions
More informationEpilepsy Surgery: Who should be considered? How will patients do? Bassel Abou-Khalil, M.D.
Epilepsy Surgery: Who should be considered? How will patients do? Bassel Abou-Khalil, M.D. Disclosures none Self-assessment questions Q1- Which qualify for drug resistance in focal epilepsy? A. Failure
More informationAnatomical and Functional MRI of the Pancreas
Anatomical and Functional MRI of the Pancreas MA Bali, MD, T Metens, PhD Erasme Hospital Free University of Brussels Belgium mbali@ulb.ac.be Introduction The use of MRI to investigate the pancreas has
More informationAutomated detection of abnormal changes in cortical thickness: A tool to help diagnosis in neocortical focal epilepsy
Automated detection of abnormal changes in cortical thickness: A tool to help diagnosis in neocortical focal epilepsy 1. Introduction Epilepsy is a common neurological disorder, which affects about 1 %
More informationMR and Positron Emission Tomography in the Diagnosis of Surgically Correctable Temporal Lobe Epilepsy
MR and Positron Emission Tomography in the Diagnosis of Surgically Correctable Temporal Lobe Epilepsy R. Heinz, N. Ferris, E. K. Lee, R. Radtke, B. Crain, J. M. Hoffman, M. Hanson, S. Paine, and A. Friedman
More informationThe Asymmetric Mamillary Body: Association with Medial Temporal Lobe Disease Demonstrated with MR
The Mamillary Body: Association with Medial Temporal Lobe Disease Demonstrated with MR Alexander C. Mamourian, Lawrence Rodichok, and Javad Towfighi PURPOSE: To determine whether mamillary body atrophy
More informationUtility of double inversion recovery MRI in paediatric epilepsy
Utility of double inversion recovery MRI in paediatric epilepsy Bruno Soares, Emory University Samuel G Porter, Emory University Amit Saindane, Emory University Seena Dehkharghani, Emory University Nilesh
More informationEssentials of Clinical MR, 2 nd edition. 14. Ischemia and Infarction II
14. Ischemia and Infarction II Lacunar infarcts are small deep parenchymal lesions involving the basal ganglia, internal capsule, thalamus, and brainstem. The vascular supply of these areas includes the
More informationCerebral cavernous malformation (CCM) comprise
ORIGINAL RESEARCH J.M. de Souza R.C. Domingues L.C.H. Cruz, Jr. F.S. Domingues T. Iasbeck E.L. Gasparetto Susceptibility-Weighted Imaging for the Evaluation of Patients with Familial Cerebral Cavernous
More informationDiffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy
AJNR Am J Neuroradiol 25:1269 1273, August 2004 Diffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy R. Nuri Sener BACKGROUND AND PURPOSE: Neuroaxonal dystrophy is a rare progressive
More informationChapter 1 Introduction
Chapter 1 Introduction Men think epilepsy divine, merely because they do not understand it. But if they called everything divine which they do not understand, why, there would be no end to divine things.
More informationNew Imaging Concepts in Central Nervous System Neoplasms
New Imaging Concepts in Central Nervous System Neoplasms Maarten Lequin Department of Pediatric Radiology Wilhelmina Children s Hospital/University Medical Center Utrecht New Imaging Concepts in Central
More informationMagnetic Resonance Imaging of Mesial Temporal Sclerosis (MTS): What radiologists ought to know?
Magnetic Resonance Imaging of Mesial Temporal Sclerosis (MTS): What radiologists ought to know? Poster No.: C-0856 Congress: ECR 2012 Type: Educational Exhibit Authors: P. Singh, G. Mittal, R. Kaur, K.
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Carrera J-P, Forrester N, Wang E, et al. Eastern equine encephalitis
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.64 Comparison of Brain Magnetic Reasoning
More informationRemission of diffusion lesions in acute stroke magnetic resonance imaging
ORIGINAL RESEARCH Remission of diffusion lesions in acute stroke magnetic resonance imaging F. A. Fellner 1, M. R. Vosko 2, C. M. Fellner 1, D. Flöry 1 1. AKH Linz, Institute of Radiology, Austria. 2.
More informationNEURO PROTOCOLS MRI NEURO PROTOCOLS (SIEMENS SCANNERS)
Page 1 NEURO PROTOCOLS Brain Stroke Brain Brain with contrast Brain for seizures Brain for MS Brain for Pineal gland Sella FAST Scan for hydrocephalus MRA/MRV Brain MRA carotids 8 th nerve Cranial nerves
More informationThe relevance of somatosensory auras in refractory temporal lobe epilepsies
BRIEF COMMUNICATION The relevance of somatosensory auras in refractory temporal lobe epilepsies Ghazala Perven, Ruta Yardi, Juan Bulacio, Imad Najm, William Bingaman, Jorge Gonzalez-Martinez, and Lara
More informationSeizure Semiology and Neuroimaging Findings in Patients with Midline Spikes
Epilepsia, 42(12):1563 1568, 2001 Blackwell Science, Inc. International League Against Epilepsy Seizure Semiology and Neuroimaging Findings in Patients with Midline Spikes *Ekrem Kutluay, *Erasmo A. Passaro,
More informationFig. 1. Localized single voxel proton MR spectroscopy was performed along the long axis of right hippocampus after extension of patient s head to
125 A B C Fig. 1. Localized single voxel proton MR spectroscopy was performed along the long axis of right hippocampus after extension of patient s head to obtain entire dimension of the hippocampal body.
More informationAmyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative
ORIGINAL RESEARCH E. Matsusue S. Sugihara S. Fujii T. Kinoshita T. Nakano E. Ohama T. Ogawa Cerebral Cortical and White Matter Lesions in Amyotrophic Lateral Sclerosis with Dementia: Correlation with MR
More informationTuberous sclerosis: Evaluation of intracraneal lesions
Tuberous sclerosis: Evaluation of intracraneal lesions Poster No: C-3394 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro Authors: J R Docampo, M Cabrini, C Morales, C Bruno; Buenos Aires/ AR
More informationEPILEPSY 2018: UPDATE ON MODERN SURGICAL MANAGEMENT. Robert Kellogg, MD Advocate Children s Hospital Park Ridge, IL April 20, 2018
EPILEPSY 2018: UPDATE ON MODERN SURGICAL MANAGEMENT Robert Kellogg, MD Advocate Children s Hospital Park Ridge, IL April 20, 2018 No disclosures OBJECTIVES Brief history of epilepsy surgery Pre-operative
More informationClassification of Epilepsy: What s new? A/Professor Annie Bye
Classification of Epilepsy: What s new? A/Professor Annie Bye The following material on the new epilepsy classification is based on the following 3 papers: Scheffer et al. ILAE classification of the epilepsies:
More informationHemimegalencephaly without seizures: report of a case and review of literature
Romanian Neurosurgery Volume XXXI Number 3 2017 July-September Article Hemimegalencephaly without seizures: report of a case and review of literature Agrawal Atul, Dutta Gautam, Singh Daljit, Sachdeva
More informationSpike voltage topography in temporal lobe epilepsy
Thomas Jefferson University Jefferson Digital Commons Department of Neurology Faculty Papers Department of Neurology 5-17-2016 Spike voltage topography in temporal lobe epilepsy Ali Akbar Asadi-Pooya Thomas
More informationTuberous sclerosis: Evaluation of intracraneal lesions
Tuberous sclerosis: Evaluation of intracraneal lesions Poster No.: C-3394 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro - Your latest results Authors: J. R. Docampo, M. Cabrini, C. Morales,
More informationDifferentiation between peritrigonal terminal zones and hypoxic-ischemic white matter injury on MRI
Chapter 4 Differentiation between peritrigonal terminal zones and hypoxic-ischemic white matter injury on MRI Lishya Liauw Jeroen van der Grond Valerie Slooff Francisca Wiggers-de Bruïne Laura Laan Saskia
More informationIntroduction to Neurosurgical Subspecialties:
Introduction to Neurosurgical Subspecialties: Pediatric Neurosurgery Brian L. Hoh, MD 1 and Gregory J. Zipfel, MD 2 1 University of Florida, 2 Washington University Pediatric Neurosurgery Pediatric neurosurgeons
More informationJournal of Radiology Case Reports
Pediatric Holohemispheric Developmental Venous Anomaly: Definitive characterization by 3D Susceptibility Weighted Magnetic Resonance Angiography Michael A. Casey 1, Sourabh Lahoti 2, Ajeet Gordhan 2* 1.
More informationEpilepsy and Brain Tumor. Apasri Lusawat M.D. Pediatric Neurology Prasat Neurological Institute
Epilepsy and Brain Tumor Apasri Lusawat M.D. Pediatric Neurology Prasat Neurological Institute Outline Overview Pathogenesis : Tumor-> epilepsy Etiology of Epilepsy, age EPILEPSY AND BRAIN TUMORS CNS neoplasms
More informationacute-onset, severe, recurrent reversible vasoconstriction
1 RCVS A clinical and radiologic syndrome Characterized by acute-onset, severe, recurrent headache and reversible vasoconstriction of the cerebral arteries RCVS accounts for most benign thunderclap headaches"
More informationMRI PEDIATRIC PROTOCOLS (Updated 6/19/2018)
MRI PEDIATRIC PROTOCOLS (Updated 6/19/2018) *Please get or let us know where radiologist can review plain films. *For Texas Orthopedics and other Docs requesting only MSK section read for their pediatric
More informationLevel 4 comprehensive epilepsy program in Malaysia, a resource-limited country
Neurology Asia 2017; 22(4) : 299 305 Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country 1 Kheng-Seang Lim, 1 Sherrini Ahmad Bazir Ahmad, 2 Vairavan Narayanan, 3 Kartini Rahmat,
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationElectro-clinical manifestations of the epilepsy associated to the different anatomical variants of hypothalamic hamartomas
Electro-clinical manifestations of the epilepsy associated to the different anatomical variants of hypothalamic hamartomas Alberto JR Leal Hospital Fernando Fonseca, Dep. Neurology Lisbon. Abstract Objective
More informationVisualization strategies for major white matter tracts identified by diffusion tensor imaging for intraoperative use
International Congress Series 1281 (2005) 793 797 www.ics-elsevier.com Visualization strategies for major white matter tracts identified by diffusion tensor imaging for intraoperative use Ch. Nimsky a,b,
More informationSURGICAL MANAGEMENT OF DRUG-RESISTANT FOCAL EPILEPSY
SURGICAL MANAGEMENT OF DRUG-RESISTANT FOCAL EPILEPSY Gregory D. Cascino, MD, FAAN Epilepsy surgery is underutilized in patients with focal seizures refractory to appropriate antiepileptic drug (AED) trials
More informationSupratentorial cerebral arteriovenous malformations : a clinical analysis
Original article: Supratentorial cerebral arteriovenous malformations : a clinical analysis Dr. Rajneesh Gour 1, Dr. S. N. Ghosh 2, Dr. Sumit Deb 3 1Dept.Of Surgery,Chirayu Medical College & Research Centre,
More informationTemporal lobe epilepsy in children: overview of clinical semiology
Review article Epileptic Disord 2005; 7 (4): 299-307 Temporal lobe epilepsy in children: overview of clinical semiology Amit Ray 1, Prakash Kotagal 2 1 Department of Neurology, Fortis Hospital, Delhi,
More informationDiffuse Proliferative Cerebral Angiopathy: A case report and review of the literature
Diffuse Proliferative Cerebral Angiopathy: A case report and review of the literature Rohit 1*, Poh Sun Goh 1 1. Department of Radiology, National University hospital, Singapore * Correspondence: Dr. Rohit,
More informationNEURORADIOLOGY Part I
NEURORADIOLOGY Part I Vörös Erika University of Szeged Department of Radiology SZEGED BRAIN IMAGING METHODS Plain film radiography Ultrasonography (US) Computer tomography (CT) Magnetic resonance imaging
More information