|Year : 2019 | Volume
| Issue : 1 | Page : 55-56
Macroscopic and microscopic perfusion changes in hemispheric status epilepticus with cross cerebellar diaschisis
Sameer Vyas1, Vikas Bhatia1, Gargi Dass2, Naveen Sankhyan2
1 Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
2 Department of Paediatric Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
|Date of Web Publication||18-Jun-2019|
Dr. Sameer Vyas
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Hemispheric status epilepticus showing both macroscopic (MR angiography) and microscopic (arterial spin labelling) perfusion abnormalities with crossed cerebellar diachisis is an unusual and interesting phenomenon, which occurs following sequelae of various insults.
|How to cite this article:|
Vyas S, Bhatia V, Dass G, Sankhyan N. Macroscopic and microscopic perfusion changes in hemispheric status epilepticus with cross cerebellar diaschisis. J Pediatr Neurosci 2019;14:55-6
An 11-year-old developmentally normal girl presented to the emergency with status epilepticus and left-sided hemiplegia. She was on antiepileptic medication for left-sided focal seizures since 3 years of age, and had been seizure free and off medication for the last 3 years. Presently, status was controlled medically. Magnetic resonance imaging brain [Figure 1] revealed T2 hyperintensity and diffusion restriction in the entire right cerebral and left cerebellar cortex suggestive of cortical edema. Diffusely prominent right anterior cerebral artery and middle cerebral artery branches were seen on time of flight magnetic resonance angiography (TOF MRA) suggestive of increased flow and vasodilatation. Arterial spin labeling (ASL) perfusion showed increased relative cerebral flow (rCBF) in the involved cortices suggestive of increased flow. Electroencephalogram showed diffuse activity over the entire right hemisphere.
|Figure 1: Coronal T2-weighted image (A) showing hyperintensity (red arrows) and cortical swelling involving right cerebral and left cerebellar hemispheres. Diffusion and corresponding apparent diffusion coefficient images (B–E) show areas of restricted diffusion in these areas. Time of flight MRA (F) shows diffusely prominent right ACA and MCA branches (blue arrows). ASL perfusion (G, H) shows increased rCBF in the involved right cerebral and left cerebellar hemispheres|
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Status epilepticus is associated with an increased perfusion in the epileptogenic cortex to supply the increased metabolic demands. This is seen radiologically as both vascular dilatation and increased cerebral blood flow. Site of ictus would include the entire hemisphere in unilateral status, hence presenting with hemispherical vascular and parenchymal changes. Cerebellar involvement occurs because of its functional connectivity with the epileptogenic cortex via corticopontocerebellar pathway, similar to crossed cerebellar diaschisis and injury caused by excessive neuronal transmission from prolonged excitatory synaptic activity via these pathways.
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| References|| |
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