Skip to main content
SpringerLink
Log in

Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI)

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate pathological findings in the susceptibility weighted imaging (SWI) of patients experiencing convulsive (CSE) or non-convulsive status epilepticus (NCSE) with focal hyperperfusion in the acute setting.

Methods

Twelve patients (six with NCSE confirmed by electroencephalogram (EEG) and six patients with CSE with seizure event clinically diagnosed) underwent MRI in this acute setting (mean time between onset of symptoms and MRI was 3 h 8 min), including SWI, dynamic susceptibility contrast MR imaging (DSC) and diffusion-weighted imaging (DWI). MRI sequences were retrospectively evaluated and compared with EEG findings (10/12 patients), and clinical symptoms.

Results

Twelve out of 12 (100 %) patients showed a focal parenchymal area with pseudo-narrowed cortical veins on SWI, associated with focal hyperperfused areas (increased cerebral blood flow (CBF) and mean transit time (MTT) shortening), and cortical DWI restriction in 6/12 patients (50 %). Additionally, these areas were associated with ictal or postical EEG patterns in 8/10 patients (80 %). Most frequent acute clinical findings were aphasia and/or hemiparesis in eight patients, and all of them showed pseudo-narrowed veins in those parenchymal areas responsible for these symptoms.

Conclusion

In this study series with CSE and NCSE patients, SWI showed focally pseudo-narrowed cortical veins in hyperperfused and ictal parenchymal areas. Therefore, SWI might have the potential to identify an ictal region in CSE/NCSE.

Key Points

• The focal ictal brain regions show hyperperfusion in DSC MR-perfusion imaging.

• SWI shows focally diminished cortical veins in hyperperfused ictal regions.

• SWI has the potential to identify a focal ictal region in CSE/NCSE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Meierkord H, Holtkamp M (2007) Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6:329–339

    Article  PubMed  Google Scholar 

  2. Leppik IE (1993) Status epilepticus in the treatment of epilepsy: principles and practice. Lee and Febiger, Philadelphia

    Google Scholar 

  3. Shneker BF, Fountain NB (2003) Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 61:1066–1073

    Article  PubMed  Google Scholar 

  4. Maganti R, Gerber P, Drees C, Chung S (2008) Nonconvulsive status epilepticus. Epilepsy Behav 12:572–586

    Article  PubMed  Google Scholar 

  5. Foreman B, Hirsch LJ (2012) Epilepsy emergencies: diagnosis and management. Neurol Clin 30:11–41, vii

    Article  PubMed  Google Scholar 

  6. El-Koussy M, Mathis J, Lovblad KO, Stepper F, Kiefer C, Schroth G (2002) Focal status epilepticus: follow-up by perfusion- and diffusion MRI. Eur Radiol 12:568–574

    Article  PubMed  CAS  Google Scholar 

  7. Toledo M, Munuera J, Sueiras M, Rovira R, Alvarez-Sabin J, Rovira A (2008) MRI findings in aphasic status epilepticus. Epilepsia 49:1465–1469

    Article  PubMed  Google Scholar 

  8. Hauf M, Slotboom J, Nirkko A, von Bredow F, Ozdoba C, Wiest R (2009) Cortical regional hyperperfusion in nonconvulsive status epilepticus measured by dynamic brain perfusion CT. AJNR Am J Neuroradiol 30:693–698

    Article  PubMed  CAS  Google Scholar 

  9. Masterson K, Vargas MI, Delavelle J (2009) Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol 36:48–51

    Article  PubMed  CAS  Google Scholar 

  10. Szabo K, Poepel A, Pohlmann-Eden B et al (2005) Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain 128:1369–1376

    Article  PubMed  Google Scholar 

  11. Hauf M, Wiest R, Schindler K et al (2013) Common mechanisms of auditory hallucinations-perfusion studies in epilepsy. Psychiatry Res 211:268–270

    Article  PubMed  Google Scholar 

  12. Canas N, Breia P, Soares P et al (2010) The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities. Epilepsy Res 91:240–252

    Article  PubMed  Google Scholar 

  13. Hong KS, Cho YJ, Lee SK, Jeong SW, Kim WK, Oh EJ (2004) Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure 13:317–321

    Article  PubMed  Google Scholar 

  14. Fahrendorf D, Schwindt W, Wolfer J et al (2013) Benefits of contrast-enhanced SWI in patients with glioblastoma multiforme. Eur Radiol 23:2868–2879

    Article  PubMed  Google Scholar 

  15. Gramsch C, Goricke SL, Behrens F et al (2013) Isolated cerebral susceptibility artefacts in patients with malignant melanoma: metastasis or not? Eur Radiol 23:2622–2627

    Article  PubMed  Google Scholar 

  16. Mittal S, Wu Z, Neelavalli J, Haacke EM (2009) Susceptibility-weighted imaging: technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 30:232–252

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj K, Kapilamoorthy TR (2009) Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol 64:74–83

    Article  PubMed  CAS  Google Scholar 

  18. Hermier M, Nighoghossian N (2004) Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke 35:1989–1994

    Article  PubMed  Google Scholar 

  19. Saini J, Kesavadas C, Thomas B et al (2009) Susceptibility weighted imaging in the diagnostic evaluation of patients with intractable epilepsy. Epilepsia 50:1462–1473

    Article  PubMed  Google Scholar 

  20. Kao HW, Tsai FY, Hasso AN (2012) Predicting stroke evolution: comparison of susceptibility-weighted MR imaging with MR perfusion. Eur Radiol 22:1397–1403

    Article  PubMed  Google Scholar 

  21. Huang P, Chen CH, Lin WC, Lin RT, Khor GT, Liu CK (2012) Clinical applications of susceptibility weighted imaging in patients with major stroke. J Neurol 259:1426–1432

    Article  PubMed  Google Scholar 

  22. Verschuuren S, Poretti A, Buerki S, Lequin MH, Huisman TA (2012) Susceptibility-weighted imaging of the pediatric brain. AJR Am J Roentgenol 198:W440–W449

    Article  PubMed  Google Scholar 

  23. Bosemani T, Burton VJ, Felling RJ et al (2013) Pediatric hemiplegic migraine: role of multiple MRI techniques in evaluation of reversible hypoperfusion. Cephalalgia. doi:10.1177/0333102413509432

    PubMed  Google Scholar 

  24. Lee YJ, Shon YM, Yoo WJ, Jung SL, Kim BS, Ahn KJ (2013) Diminished visibility of cerebral venous vasculature in subclinical status epilepticus by susceptibility-weighted imaging: a case report. Clin Neuroradiol. doi:10.1007/s00062-013-0204-3

    Google Scholar 

  25. Zhao M, Suh M, Ma H, Perry C, Geneslaw A, Schwartz TH (2007) Focal increases in perfusion and decreases in hemoglobin oxygenation precede seizure onset in spontaneous human epilepsy. Epilepsia 48:2059–2067

    Article  PubMed  Google Scholar 

  26. Wasterlain CG, Fujikawa DG, Penix L, Sankar R (1993) Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia 34:S37–S53

    Article  PubMed  Google Scholar 

  27. Unrath A, Muller HP, Ludolph AC, Kassubek J (2012) Reversible cortical diffusion restriction, hyperperfusion and T2-hyperintensity caused by two different types of epileptic seizure. Clin Neuroradiol 22:239–243

    Article  PubMed  CAS  Google Scholar 

  28. Xing W, Wang X, Xie F, Liao W (2013) Application of dynamic susceptibility contrast-enhanced perfusion in temporal lobe epilepsy. Acta Radiol 54:107–112

    PubMed  Google Scholar 

  29. Ge Y, Zohrabian VM, Osa EO et al (2009) Diminished visibility of cerebral venous vasculature in multiple sclerosis by susceptibility-weighted imaging at 3.0 Tesla. J Magn Reson Imaging 29:1190–1194

    Article  PubMed  PubMed Central  Google Scholar 

  30. Tsui YK, Tsai FY, Hasso AN, Greensite F, Nguyen BV (2009) Susceptibility-weighted imaging for differential diagnosis of cerebral vascular pathology: a pictorial review. J Neurol Sci 287:7–16

    Article  PubMed  Google Scholar 

  31. Thomas B, Somasundaram S, Thamburaj K et al (2008) Clinical applications of susceptibility weighted MR imaging of the brain - a pictorial review. Neuroradiology 50:105–116

    Article  PubMed  Google Scholar 

  32. Tong KA, Ashwal S, Obenaus A, Nickerson JP, Kido D, Haacke EM (2008) Susceptibility-weighted MR imaging: a review of clinical applications in children. AJNR Am J Neuroradiol 29:9–17

    Article  PubMed  CAS  Google Scholar 

  33. Gelfand JM, Wintermark M, Josephson SA (2010) Cerebral perfusion-CT patterns following seizure. Eur J Neurol 17:594–601

    Article  PubMed  CAS  Google Scholar 

  34. Iwasaki H, Takeda T, Ito T et al (2014) The use of susceptibility-weighted imaging for epileptic focus localization in acute-stage pediatric encephalopathy: a case report. Pediatr Neurol 50:171–176

    Article  PubMed  Google Scholar 

  35. Bosemani T, Verschuuren SI, Poretti A, Huisman TA (2013) Pitfalls in susceptibility-weighted imaging of the pediatric brain. J Neuroimaging. doi:10.1111/jon.12051

    PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Dr. Rajeev Kumar Verma. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was not required for this study because of the retrospective design of the study. Methodology: retrospective, cross-sectional study, performed at one institution.

Author information

Authors and Affiliations

  1. University Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland

    Jerome Aellen, Raimund Kottke, Elisabeth Springer, Christian Weisstanner, Marwan El-Koussy, Gerhard Schroth, Roland Wiest, Jan Gralla & Rajeev K. Verma

  2. Department of Neurology, Inselspital, University of Bern, Bern, Switzerland

    Eugenio Abela & Kaspar Schindler

  3. Department of Neuropaediatrics, University Children’s Hospital, Inselspital, Bern, Switzerland

    Sarah E. Buerki

Authors
  1. Jerome Aellen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugenio Abela
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah E. Buerki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raimund Kottke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisabeth Springer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaspar Schindler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Weisstanner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marwan El-Koussy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gerhard Schroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roland Wiest
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jan Gralla
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rajeev K. Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajeev K. Verma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aellen, J., Abela, E., Buerki, S.E. et al. Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI). Eur Radiol 24, 2980–2988 (2014). https://doi.org/10.1007/s00330-014-3284-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3284-9

Keywords

Search

Navigation