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Atypical postictal transient subcortical T2 hypointensity in a newly diagnosed diabetic patient with seizures Volume 20, issue 3, June 2018

TEST YOURSELF

(1) What are common findings on postictal MRI?

(2) Is subcortical signal abnormality common postictally?

(3) What can lead to subcortical T2 hypointensity during the postictal state?

 

 

 

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Answers

(1) Postictal MRI commonly presents with cortical T2 hyperintensity and swelling, restricted diffusion on DWI, and adjacent gyral and/or leptomeningeal enhancement. Such findings have a transient nature, and most commonly only a gliotic focus can result in a permanent sequela.

(2) Usually, signal abnormalities are reported at the cortical level, or may extend to the juxtacortical region; subcortical involvement on postictal MRI, such as the T2 hypointensity reported here, is rare and is typical of other pathological conditions, such as meningitis, encephalitis, metastases, or blood glucose alteration.

(3) In certain pathological conditions, the extracellular space equilibrium can be influenced by accumulation of free radicals, leading to reduction of water content, and thus T2 hypointensity. This can be the only finding on MRI, making diagnosis more difficult.

 

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