John Libbey Eurotext

ILAE Neuroimaging Task Force highlight: Review MRI scans with semiology in mind Volume 22, issue 5, October 2020


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1 Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
2 Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre and Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
3 Multimodal Imaging and Connectome Analysis lab, McConnell Brain Imaging Centre and Montreal Neurological Institute, McGill University, Montreal, Canada
4 Departments of Neurology, Neuroscience, and Neurosurgery, Yale University, New Haven, USA
5 Department of Neurology, University of Campinas – UNICAMP, Campinas, SP, Brazil
6 Phramongkutklao hospital, Bangkok, Thailand
7 The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
8 Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, USA
9 Department of Neurosurgery, University Hospital Erlangen, Germany
10 Neurology Unit, University of Modena and Reggio Emilia, Modena, Italy
11 Epilepsy Center, Cleveland Clinic, Cleveland, USA
* Correspondence: Paolo Federico Room C1220, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada T2N 2T9

The ILAE Neuroimaging Task Force aims to publish educational case reports highlighting basic aspects related to neuroimaging in epilepsy consistent with the educational mission of the ILAE. It is important to obtain MRI scans early in the clinical course of epilepsy, using an optimized protocol. Furthermore, it is critical that MRI scans are reviewed by experts who have been provided with all the clinical information and results from other investigations. We report a patient with a 21-year history of drug-resistant seizures who was admitted from another centre for presurgical evaluation. She had four previous MRI scans from this centre which were reported as unremarkable. However, a review of the MRI scan obtained on the day of admission, with the patient's ictal semiology in mind, resulted in identification of an epileptogenic lesion which was later confirmed by video-EEG monitoring and interictal PET. This lesion was present on all previous MRI scans and showed no change. The patient underwent lesionectomy, and histopathology of the resected specimen was consistent with a dysembryoplastic neuroepithelial tumour. The patient remains seizure-free, 2.5 years after surgery. This case highlights the importance of obtaining detailed descriptions of seizure semiology and considering them when reviewing MR images.