39:446 症例報告 39: 446 450, 2017 MRI 1 1 2 3 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 / 2 2 3 2016 9 15 2016 10 17 doi: 10.3995/jstroke.10489 201X 5 10 5 H 147 cm 63.9 kg 132/75 mmhg 86/ 36.2 C JCSI-3 2.5 mm 19.82 10 3 /μl CRP 0.36 mg/dl X CTR 52
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. 4 2 80 mmh 2 O 6/3 mm 3 38 mg/dl CT Holter 3 200 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
39:448 脳卒中 39 6 2017 11 考 NCSE 4 NCSE MRI 2 MRI Chatzikonstantinou 5 MRI 54 14 26 Ohe 6 225 17 7.6 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 14 11 79 14 7 50 7 8 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
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: 1964 1972, 2013 2 Chatzikonstantinou A, Gass A, Förster A, et al: Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45 51, 2011 3 Scott RC, King MD, Gadian DG, et al: Prolonged febrile seizures are associated with hippocampal vasogenic edema and developmental changes. Epilepsia 47: 1493 1498, 2006 4 Brain Nerve 68: 451 452, 2016 5 Chatzikonstantinou A, Gass A, Förster A, et al: Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45 51, 2011 6 Ohe Y, Hayashi T, Deguchi I, et al: MRI abnormality of the pulvinar in patients with status epilepticus. J Neuroradiol 41: 220 226, 2014 7 Wilke M, Turchi J, Smith K, et al: Pulvinar inactivation disrupts selection of movement plans. J Neurosci 30: 8650 8659, 2010 8 Grieve KL, Acuña C, Cudeiro J: The primate pulvinar nuclei: vision and action. Trends Neurosci 23: 35 39, 2000 9 Benveniste H, Hedlund LW, Johnson GA: Mechanism of detection of acute cerebral ischemia in rats by diffusion-weighted magnetic resonance microscopy. Stroke 23: 746 754, 1992 10 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 181 193 11 Klatzo I: Presidental address. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol 26: 1 14, 1967 12 Schwartz RB, Mulkern RV, Gudbjartsson H, et al: Diffusionweighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR Am J Neuroradiol 19: 859 862, 1998 13 Toledo M, Munuera J, Sueiras M, et al: MRI findings in aphasic status epilepticus. Epilepsia 49: 1465 1469, 2008 14 Hong KS, Cho YJ, Lee SK, et al: Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure 13: 317 321, 2004 15 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: 731 738, 2015 16 NCSE NCSE Brain Nerve 67: 545 552, 2015 17 Mendes A, Sampaio L: Brain magnetic resonance in status epilepticus: A focused review. Seizure 38: 63 67, 2016 18 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: 228 237, 2016 19 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: 313 317, 2008 20 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: 333 339, 1999
39:450 脳卒中 39 6 2017 11 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: 446 450, 2017)