ABSTRACT
OBJECTIVE: To study the frequency, imaging characteristics, and clinical predictors for development of periictal diffusion weighted MRI abnormalities. METHODS: We prospectively analyzed electro clinical and imaging characteristic of adult patients with cluster of seizures or status epilepticus between November 2013 and November 2015, in whom the diffusion weighted imaging was done within 24h after the end of last seizure (clinical or electrographic). RESULTS: There were thirty patients who fulfilled the inclusion and exclusion criteria. Twenty patients (66%) had periictal MRI abnormalities. Nine patients (34%) did not have any MRI abnormality. All the patients with PMA had abnormalities on diffusion weighted imaging (DWI). Hippocampal abnormalities were seen in nine (53%), perisylvian in two (11.7%), thalamic in five (30%), splenium involvement in two (11.7%) and cortical involvement (temporo-occipital, parieto-occipital, temporo-parietal, fronto-parietal and fronto-temporal) in sixteen (94.1%) patients. Complete reversal of DWI changes was noted in sixteen (80%) patients and four (20%) patients showed partial resolution of MRI abnormalities. Mean duration of seizures was significantly higher among patients with PMA (59.11+20.97h) compared to those without MRI changes (27.33+9.33h) (p<0.001). CONCLUSIONS: Diffusion abnormalities on MRI are common in patients with cluster of seizures and status epilepticus and were highly concordant with clinical semiology and EEG activity. Patients with longer duration of seizures/status were more likely to have PMA.
Subject(s)
Diffusion Magnetic Resonance Imaging , Seizures/diagnostic imaging , Status Epilepticus/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Diffusion Magnetic Resonance Imaging/methods , Electroencephalography/methods , Female , Humans , Male , Middle Aged , Prospective Studies , Seizures/complications , Seizures/pathology , Status Epilepticus/complications , Status Epilepticus/pathology , Young AdultABSTRACT
Pleomorphic xanthoastrocytomas are indolent, astrocytic tumors usually located in the superficial cerebral cortex. They have not been described as occurring in the pineal region. We describe a patient with an astrocytic tumor arising in the pineal region that fulfilled all of the morphologic and immunohistochemical criteria of a pleomorphic xanthoastrocytoma. To our knowledge, this is the first description of a pleomorphic xanthoastrocytoma located in the pineal region.