소아에서 장시간의 경련 후 드문 가역적 뇌자기공명영상 변화를 보였던 증례들
Rare Reversible MRI changes after Prolonged Seizures in Children: Case Series
Abstract
Backgrounds: Without structural causes, various transient changes of brain magnetic resonance imaging(MRI) can appear during periictal period of seizure. Here we report different cases of atypical lesions in MRI performed after prolonged seizure or status epilepticus. Case presentation: Patient 1 was a 32-month-old boy came to the hospital with afebrile generalized seizure for 20 minutes. Electroencephalography(EEG) showed encephalopathic changes. In perfusion MRI, large decreased and delayed perfusion was found at left hemisphere. He recovered soon and parainfluenza virus was identified from respiratory sample. Seven days later, MRI changes were normalized and reversible cerebral vasoconstriction syndrome was suggested. Patient 2 was a 42-month-old boy, with a history of afebrile seizure came for generalized seizure for 35 minutes. He showed fever, irritability and ataxia and then completely recovered. Cerebrospinal fluid (CSF) pressure was high (28mmH₂O). EEG showed frontal epileptiform discharges. On diffusion MRI, huge diffusion restrictions were seen in bilateral frontal lobes, insular, callosal, and thalamus. Followed images showed sequential improvements. Patient 3 was a 6-year-old girl who came for nonconvulsive and convulsive status epilepticus for more than one hour. During seizure, her left arm was paralyzed and then came to tonic. MRI showed focal leptomeningeal enhancement at right frontal lobe. EEG showed frequent right focal spikes. CSF was normal. Followed MRI at one week later showed complete resolution. Conclusion: Various transient lesions may explain the pathophysiologic mechanisms of prolonged seizures. As these changes can rapidly disappear, the sooner timing of MRI acquisition should be considered.