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Hippocampal MRI Signal Hyperintensity After Febrile Status Epilepticus Is Predictive of Subsequent Mesial Temporal Sclerosis

¹ All authors: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Graph shows initial and follow-up volumes in hippocampus with abnormal signal intensity on initial imaging (patients 1–7 in Table 1). For patient 2, solely hippocampus with most abnormal signal intensity is depicted. Children with solely normal hippocampal signal intensity (patients 8–11) are not included in this graph. Each child's hippocampus is denoted by single color different from other children; numbers in graph correlate to patient numbers in Table 1. Graph compares hippocampal volume change over time with growth curve of normal hippocampal volumes (black line) generated from normal MR scans of 30 children of various ages who had no history of developmental delay or seizures. Varying degrees of hippocampal volume decrease are seen in six of seven children. Furthermore, degree of volume loss is most marked in patients 1–3, who had moderate or severe signal abnormality within hippocampus represented here.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Graph shows initial and follow-up volumes in hippocampus contralateral to hippocampus with most abnormal signal intensity on initial imaging in patients 1–7. Each child's hippocampus is demarcated by different color; numbers in graph correlate to patient numbers in Table 1. All hippocampi depicted had normal signal intensity except that shown for patient 2, which had minimally increased signal intensity (see Table 1). Graph com pares hippocampal volume change over time with growth curve of normal hippocampal volumes (black line) generated from normal MR scans of 30 children of various ages who had no history of developmental delay or seizures.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Graph shows correspondence between hippocampal signal intensity on initial imaging and changes in hippocampal volumes over time with superimposed linear fit of data (black line). Strong correlation is shown between degree of hippocampal signal abnormality and degree of volume loss (R = 0.756). Hippocampal signal intensity was graded on a numeric scale as follows: 0 = normal, 1 = minimally increased, 2 = mildly increased, 3 = moderately increased, or 4 = markedly increased.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Bilateral hippocampal volume loss despite initial signal abnormality in only one hippocampus in 28-month-old female infant (patient 1) with febrile status epilepticus. Seizure activity was localized to right cerebral hemisphere and was manifested by left arm and leg twitching lasting 216 minutes. Coronal T2-weighted fast spin-echo MR image at time of status epilepticus shows hyperintense signal in right hippocampus (arrow). Initial right hippocampal signal intensity was graded as moderate signal intensity increase (score of 3) and left hippocampal signal intensity was graded as normal (score of 0). Right hippocampal volume measured 3,634 mm3 and left hippocampal volume measured 3,361 mm3.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Bilateral hippocampal volume loss despite initial signal abnormality in only one hippocampus in 28-month-old female infant (patient 1) with febrile status epilepticus. Seizure activity was localized to right cerebral hemisphere and was manifested by left arm and leg twitching lasting 216 minutes. Coronal T2-weighted fast spin-echo MR image obtained 9 months after status epilepticus shows right hippocampus still has increased signal intensity, although it has diminished from initial scan shown in A. On this study, right hippocampal signal intensity was graded as mildly increased (score of 2) and left hippocampal was again graded as normal (score of 0). Compared with initial image shown in A, on visual inspection alone moderate decrease in size of right hippocampus and mild decrease in size of left hippocampus are seen. On volumetric analysis, right hippocampal volume was found to be decreased by 1,084 mm3 and left hippocampal volume decreased by 232 mm3.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Graph shows initial and follow-up hippocampal volumes in four children (patient 8 [], 9 [•], 10 [], and 11 [] in Table 1) with normal hippocampal signal intensity on initial imaging. Graph shows varying degrees of volume increase in three children and minimal volume decrease in one hippocampus in one child. Black line shows growth curve of normal hippocampal volumes generated from normal MR scans of 30 children of various ages who had no history of developmental delay or seizures.

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