MRI demonstrates brain edema due to hyperperfusion with NCSE 39:447 CT MRI 7 DWI ADC-map FLAIR DWI Fig. 1 MRA 2 MRI DWI ADC-map FLAIR Fig. 2 3 FLAIR F
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1 39:446 症例報告 39: , 2017 MRI 要旨 84 MRI 2 MRI ADC-map FLAIR 3 ASL MRA MCA 16 MRI MRI ASL Key words: nonconvulsive status epilepticus, mimicking cerebral infarction, magnetic resonance imaging, arterial spin labeling, hyperperfusion はじめに MRI DWI ADC-map 1 3 DWI nonconvulsive status epilepticus: NCSE 1 DWI 症 1 例 84 1 / doi: /jstroke X H 147 cm 63.9 kg 132/75 mmhg 86/ 36.2 C JCSI mm /μl CRP 0.36 mg/dl X CTR 52
2 MRI demonstrates brain edema due to hyperperfusion with NCSE 39:447 CT MRI 7 DWI ADC-map FLAIR DWI Fig. 1 MRA 2 MRI DWI ADC-map FLAIR Fig. 2 3 FLAIR Fig. 3 MRA ASL arterial spin labeling Fig mmh 2 O 6/3 mm 3 38 mg/dl CT Holter mg/ 16 DWI FLAIR 2 Fig. 5 Fig. 2 2 MRI ADCmap A D DWI B E ADC-map C F FLAIR Fig. 1 MRI A DWI B ADC-map C FLAIR D DWI Fig. 3 3 MRI A C 3D-FLAIR B D MRI
3 39:448 脳卒中 考 NCSE 4 NCSE MRI 2 MRI Chatzikonstantinou 5 MRI Ohe Fig. 4 3 MRI MRA MCA ASL A 3D TOF MRA B arterial spin labeling ASL Fig. 5 MRI 16 DWI FLAIR A 16 DWI B 16 FLAIR C 2 FLAIR 察 ADC-map ADC-map MRI ADC-map FLAIR 2 MRI ADC-map 9 ADC-map 10 Na/K MRI MRA ASL blood-brain barrier: BBB 11, 12 MRA 13, 14
4 MRI demonstrates brain edema due to hyperperfusion with NCSE 39:449 ASL 15, 16 posterior reversible encephalopathy syndrome PRES MRI PRES PRES 17, 18 Migranious infarction 19 T2 shine through 20 結 NCSE MRI MR COI COI 語 参考文献 1 Cianfoni A, Caulo M, Cerase A, et al: Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol 82: , Chatzikonstantinou A, Gass A, Förster A, et al: Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45 51, Scott RC, King MD, Gadian DG, et al: Prolonged febrile seizures are associated with hippocampal vasogenic edema and developmental changes. Epilepsia 47: , Brain Nerve 68: , Chatzikonstantinou A, Gass A, Förster A, et al: Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45 51, Ohe Y, Hayashi T, Deguchi I, et al: MRI abnormality of the pulvinar in patients with status epilepticus. J Neuroradiol 41: , Wilke M, Turchi J, Smith K, et al: Pulvinar inactivation disrupts selection of movement plans. J Neurosci 30: , Grieve KL, Acuña C, Cudeiro J: The primate pulvinar nuclei: vision and action. Trends Neurosci 23: 35 39, Benveniste H, Hedlund LW, Johnson GA: Mechanism of detection of acute cerebral ischemia in rats by diffusion-weighted magnetic resonance microscopy. Stroke 23: , Fountain BN: Cellular damage and the neuropathology of status epilepticus. In Drislane WF (eds): Status epilepticus-a clinical perspective-. New Jersey, Humana press, 2010, pp Klatzo I: Presidental address. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol 26: 1 14, Schwartz RB, Mulkern RV, Gudbjartsson H, et al: Diffusionweighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR Am J Neuroradiol 19: , Toledo M, Munuera J, Sueiras M, et al: MRI findings in aphasic status epilepticus. Epilepsia 49: , Hong KS, Cho YJ, Lee SK, et al: Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure 13: , Kanazawa Y, Morioka T, Arakawa S, et al: Nonconvulsive partial status epilepticus mimicking recurrent infarction revealed by diffusion-weighted and arterial spin labeling perfusion magnetic resonance images. J Stroke Cerebrovasc Dis 24: , NCSE NCSE Brain Nerve 67: , Mendes A, Sampaio L: Brain magnetic resonance in status epilepticus: A focused review. Seizure 38: 63 67, Wakisaka K, Morioka T, Shimogawa T, et al: Epileptic Ictal Hyperperfusion on Arterial Spin Labeling Perfusion and Diffusion- Weighted Magnetic Resonance Images in Posterior Reversible Encephalopathy Syndrome. J Stroke Cerebrovasc Dis 25: , Arai S, Utsunomiya H, Arihiro S, et al: Migrainous infarction in an adult: evaluation with serial diffusion-weighted images and cerebral blood flow studies. Radiat Med 26: , Burdette JH, Elster AD, Ricci PE: Acute cerebral infarction: quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images. Radiology 212: , 1999
5 39:450 脳卒中 Abstract MRI demonstrates edematous lesion due to hyperperfusion in the thalamus, limbic system, and cerebral cortex with nonconvulsive status epilepticus: a case report Syouichi Arai, M.D., 1) Yasutaka Kumai, M.D., 2) and Hidetsuna Utsunomiya, M.D. 3) 1) Department of Neuroradiology, Ecotope Geriatric Health Services Facility 2) Departments of Cerebrovascular Medicine, Hakujyuji Hospital 3) Departments of Center for Pediatric Neurology, Takatsuki General Hospital We report the case of an 84-year-old man with mild confusion and aphasia due to nonconvulsive status epilepticus (NCSE), giving special attention to chronological changes in the magnetic resonance imaging (MRI). The emergent diffusion-weighted imaging (DWI) showed slight hyperintensity, and the apparent diffusion coefficient map (ADC-map) showed decreased diffusion in the left pulvinar and hippocampus, which were the suspicious of acute cerebral infarction. Three days after the onset, DWI showed marked hyperintensity in the ipsilateral pulvinar, hippocampus, amygdala, uncus, and cerebral cortex. ADC-map showed combined decreased and increased diffusion. These signal changes indicated vasogenic and/or cytotoxic edema in the acute phase of NCSE. The arterial spin labeling and MR angiography demonstrated ipsilateral regional hyperperfusion. Follow-up MRI showed partial reversible brain damage. These images may reflect chronological changes in the cerebral edema due to hyperperfusion with NCSE. Key words: nonconvulsive status epilepticus, mimicking cerebral infarction, magnetic resonance imaging, arterial spin labeling, hyperperfusion (Jpn J Stroke 39: , 2017)
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