Reversible cMRI Changes After Status Epilepticus: Two Case Reports And a Review

Background: cMRI is the standard test for classifying the type of epilepsy, i.e., to rule in or rule out structural epilepsy. Some patients display non-specific lesions that are not considered epileptogenic. Sometimes, however, abnormalities that do not conclusively fit a category are displayed and this is where the differential diagnosis should include reversible postictal changes.

Methods: Case 1: A 7-year-old girl with occipital lobe epilepsy displayed bilateral parieto-occipital patchy areas of mild signal enhancement on cMRI two days after her first focal status epilepticus. Case 2: A 4-year-old girl with more than 200 partial seizures per day associated with frontal lobe epilepsy displayed patchy areas of mild signal enhancement in the right superior and medial frontal gyrus.

Results: Both children were treated with medications and became seizure-free shortly thereafter. A follow-up cMRI was performed in both children within 3 months. The changes could no longer be detected in either case. The suspected diagnosis of postictal edema was therefore confirmed.

Conclusion: Transient cMRI changes associated with epileptic seizures also occur in children, but are rare. The differential diagnosis should always include epileptogenic causes. A short-term follow-up cMRI is therefore imperative. Scientific literature contains case reports of transient diffusion abnormalities in the cortex, thalamus and hippocampus after epileptic seizures in children and adults.