Subject(s)
Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/etiology , Neuroacanthocytosis/complications , Neuroacanthocytosis/diagnosis , Adolescent , Adult , Brain/pathology , Diagnosis, Differential , Epilepsy, Partial, Sensory/diagnosis , Epilepsy, Partial, Sensory/etiology , Epilepsy, Partial, Sensory/pathology , Epilepsy, Temporal Lobe/pathology , Humans , Magnetic Resonance Imaging , Male , Neuroacanthocytosis/pathology , Vesicular Transport Proteins/metabolism , Young AdultABSTRACT
Cerebral Magnetic Resonance imaging in acute postictal period is performed to exclude structural processes that can be responsible for the epileptic activity. Sometimes, the findings are the result of the epileptic activity, and not the cause reflecting the pathophysiologic changes during epileptic activity. In this paper we describe a patient with status epilepticus who has developed hemicerebellar involvement contralateral to a frontal epileptogenic focus. This phenomenon of Reverse Crossed Cerebellar Diaschisis is rare and has been describe only in Single Photon Emission Computed Tomography (SPECT).
Subject(s)
Epilepsy, Partial, Sensory/physiopathology , Adult , Cerebellum/physiopathology , Epilepsy, Partial, Sensory/drug therapy , Epilepsy, Partial, Sensory/pathology , Female , Humans , Magnetic Resonance Imaging , Neurons/physiologyABSTRACT
Patients with mesial temporal lobe epilepsy (mTLE) exhibit marked depressions of the regional cerebral glucose metabolism (rCMRGlu) in the mesiotemporal region. We hypothesised that patients with temporal lobe epilepsy (TLE) who have a bilateral somatosensory or acoustic ( = temporolateral/SII-) aura can be differentiated from mTLE by rCMRGlu depressions primarily involving temporo-perisylvian locations. We therefore used this ictal semiology as a clinical criterion to define a subgroup of such patients and measured the rCMRGlu in 16 patients with TLE as evident from interictal and ictal EEG-video monitoring. Clinically, they presented with medically refractory complex partial seizures and were subjected to presurgical evaluation. The pattern of the interictal rCMRGlu in the TLE patients was different from that observed in patients with mTLE and showed significant depressions ipsilateral to the epileptic focus in mesial temporal and lateral temporal regions but spared the thalamus. The neocortical metabolic depressions were spatially more extended in right than in left TLE patients. Magnetic resonance images (MRI) were either normal (n = 5) or revealed unilateral or bilateral hippocampal atrophy/sclerosis (n = 7), or temporal or extratemporal focal cortical dysplasia (n = 4). The selected TLE patients presented here comprise a heterogeneous group showing most pronounced metabolic depressions in the lateral temporal cortex. Thus, our data suggest that non-invasive metabolic imaging can assist in identifying the neocortical symptomatogenic zone in putative temporo-perisylvian lobe epilepsy.
