RESUMO
In the congenital bilateral perisylvian syndrome, pseudobulbar symptoms, cognitive deficits and cortical malformations in the perisylvian region are typical features. We report two initially magnetic resonance imaging (MRI) negative patients from our epilepsy surgery program that shared the same seizure and ictal SPECT characteristics suggesting seizure onset localized in the perisylvian region. In one patient, reevaluation revealed perisylvian cortical malformation on MRI while in the other patient MRI was normal. In these patients, subtraction ictal SPECT coregistered with MRI (SISCOM) proved useful together with clinical data in diagnosing the patients with mild forms of perisylvian syndrome.
Assuntos
Córtex Cerebral/anormalidades , Córtex Cerebral/diagnóstico por imagem , Transtornos Cognitivos/diagnóstico por imagem , Paralisia Pseudobulbar/congênito , Paralisia Pseudobulbar/diagnóstico por imagem , Adulto , Transtornos Cognitivos/patologia , Epilepsia/diagnóstico por imagem , Epilepsia/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Síndrome , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
In the pre-surgical evaluation of epilepsy patients, different functional investigations can be combined and co-registered to computerised image processing methods to enhance their diagnostic value. A method for subtraction of interictal from ictal SPECT is used, and the result is co-registered to MR, demonstrating the change in blood flow during seizure in the patient's MR-image. The level of significance is calculated and a statistical map is produced. Recent methods for EEG source localization use the MR-image to create a model of the head, producing more accurate solutions. Cases are demonstrated illustrating results concordant with these independent methods.
