Peri-Ictal Magnetic Resonance Imaging Signal Abnormalities: Do They Exist?

Abstract

In their case report (“Peri-Ictal Imaging in Focal Status Epilepticus”), Malik and Hernandez [ [1] Malik S.I. Hernandez A.W. Peri-ictal imaging in focal status epilepticus. Pediatr Neurol. 2011; 45: 138-139 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ] assume that signal abnormalities observed on magnetic resonance imaging 1 day after a supposed episode of status epilepticus were secondary to injury provoked by the ictal phenomenon itself. Peri-ictal Imaging in Focal Status EpilepticusPediatric NeurologyVol. 45Issue 2PreviewStatus epilepticus is associated with significant morbidity and mortality. Neuroimaging is a diagnostic tool used to exclude structural abnormalities as an etiology of status epilepticus. During the early era of computed tomographic scanning, it was recognized that reversible changes can be observed after a prolonged episode of focal status epilepticus. Many case reports in the literature describe structural changes identified by magnetic resonance imaging (MRI) [1]. In status epilepticus, intrinsic neuronal activity results in the release of excessive glutamate in the synaptic cleft, causing cytotoxic edema in neurons and astrocytes. Full-Text PDF Response:Pediatric NeurologyVol. 46Issue 2PreviewWe read with interest Dr. Grillo’s remarks about our report on peri-ictal imaging in focal status epilepticus [1]. We appreciate his insights regarding our report, and agree that obscure etiologies and infectious or immune-mediated encephalopathies can cause changes on magnetic resonance imaging, similar to those in our patient. Full-Text PDF