Updates in Refractory Status Epilepticus

Figure 4

Various modalities of MR imaging showing changes associated with focal status epilepticus. A previously healthy middle-aged man presented with his first generalized tonic-clonic seizure followed by intermittent receptive dysphasia. Continuous EEG monitoring showed nonconvulsive status epilepticus originating from the left temporal leads (gray arrow in (a)). His MRI showed a focal area of abnormality involving the posterior superior aspect of the left temporal lobe. The DWI images showed a gyriform pattern of the increased signal (arrow in (b)), part of which showed decreased attenuation on an ADC map (arrow in (c)). The same area showed hypoattenuation on the T1W images with minimal pial surface enhancement (d, e) and increased signal with sulcal effacement on FLAIR images (arrow in (f)). The pathology showed neuronal necrosis, prominent reactive astrocytosis, microglial activation, and sparse mononuclear inflammation.