Imaging of Epilepsy: A Clinical Atlas

354 Pages·2022·42.638 MB·English

by  John M. Stern, Noriko Salamon

John M. Stern
Noriko Salamon
Imaging
of Epilepsy
A Clinical Atlas
123
Imaging of Epilepsy
John M. Stern • Noriko Salamon
Imaging of Epilepsy
A Clinical Atlas
John M. Stern Noriko Salamon
Department of Neurology Department of Radiology
Geffen School of Medicine, University of Geffen School of Medicine, University of
California, Los Angeles California, Los Angeles
Los Angeles, CA, USA Los Angeles, CA, USA
ISBN 978-3-030-86671-6 ISBN 978-3-030-86672-3 (eBook)
https://doi.org/10.1007/978-3-030-86672-3
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“To the patients for all that they have taught us.”
“To Jackie, my wife and partner in the adventure of life, with love and
appreciation.”
John Stern
“To Georges Salamon, who opened many doors for me.”
Noriko Salamon
Preface
The clinical evaluation of epilepsy has evolved over the recent decades to increasingly inte-
grate brain imaging as a complement to seizure semiology and electroencephalography (EEG).
Although diagnosing epilepsy can rely entirely upon the history of unprovoked seizures, deter-
mining the specific epilepsy diagnosis, which may be an epilepsy syndrome for generalized
epilepsies or a localization for focal epilepsies, depends upon the integration of imaging results
and additional diagnostic information. The aim of identifying a specific epilepsy diagnosis is
increasingly important because of the relevance to treatment selection, especially as treatment
options have increased. In particular, imaging results can substantially impact treatment rec-
ommendations for those with medication-resistant epilepsy who are considering non-
pharmacologic treatments. To provide best care, the epilepsy clinician’s skills now include a
sophisticated knowledge of epilepsy’s imaging findings. The challenge in developing this skill
arises from the broad range of findings from abnormalities that are small and subtle to obvious
and extensive, and also includes findings that are either incidental or due to epilepsy
treatment.
Achieving expertise in the interpretation of epilepsy imaging is helped by a knowledge of
the collection of findings that are potentially related to epilepsy and the relationships of each
to clinical situations. Although numerous types of imaging abnormality may cause epilepsy,
the full scope is small within all radiologic abnormalities, and its review is achievable. With
this perspective, we created a workshop for the American Epilepsy Society’s annual meeting
that reviewed the breadth of imaging findings related to epilepsy and presented the example
images within their clinical contexts. Over several years, this workshop simulated a clinical
case conference with clinical review alongside radiologic review. Essentially, we used a frame-
work built upon a synthesis of clinical history and diagnostic modalities, which is the approach
in conventional clinical practice, as an interactive educational program.
Transforming the workshop into a book was not initially considered, and we thank the pub-
lisher for proposing a reference book version of the workshop. The foundation of this book
remains our experience that clinical context is invaluable when interpreting imaging, and this
is especially important for epilepsy care with its inherent diagnostic challenges. This book
provides a comprehensive review of epilepsy’s imaging findings with the detailed clinical his-
tories that make the findings relevant. By understanding patients’ presentations and additional
diagnostic testing, this radiologic review’s purpose is to provide an education in imaging find-
ings alongside insights into the integration of diagnostic information for epilepsy.
The book is divided into parts according to general categories for the imaging findings.
Each imaging finding is presented as a collection of images across the relevant imaging modal-
ities that relate to one patient, whose history accompanies the images. This detailed presenta-
tion of one finding can be supplemented by a review of the whole category to obtain a broader
understanding of the finding in the context of related findings. Overall, the case-based organi-
zation with clinical history and multiple images is intended to provide a complete visual under-
standing of the imaging findings and the corresponding relationship of each finding to the
clinical presentation, treatment, and outcome.
We are appreciative of our colleagues in the UCLA Seizure Disorder Center, who encom-
pass the multiple disciplines needed for epilepsy care, including neurology, radiology, psy-
vii
viii Preface
chology, surgery, psychiatry, nursing, and clinical neurophysiology. We also feel honored by
the patients, as they shared their experiences with us and entrusted us with helping them over-
come epilepsy.
Los Angeles, CA, USA John M. Stern, MD
Noriko Salamon, MD, PhD
Key Words List
Epilepsy
Seizure
Focal epilepsy
Neuroradiology
Brain imaging
Epilepsy imaging
MRI (Magnetic Resonance Imaging)
FDG - PET (Fluorodeoxyglucose Positron Emission Tomography)
CT (Computerized Tomography)
DTI (Diffusion Tensor Imaging)
DWI (Diffusion-weighted Imaging)
ix
Contents
Part I Hippocampal Sclerosis
1 Mild, Unilateral Hippocampal Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Moderate, Unilateral Hippocampal Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Severe, Unilateral Hippocampal Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
4 Mild, Bilateral Hippocampal Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
5 Severe, Bilateral Hippocampal Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
6 Hippocampal Sclerosis with Normal MRI and Abnormal PET . . . . . . . . . . . . . . . 23
Part II C erebral Malformations
7 Focal Cortical Dysplasia, Type I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
8 Focal Cortical Dysplasia, Type IIa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
9 Focal Cortical Dysplasia, Type IIb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
10 Focal Cortical Dysplasia, Type IIIb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
11 Focal Cortical Dysplasia with the Transmantle Sign . . . . . . . . . . . . . . . . . . . . . . . . 45
12 Focal Cortical Dysplasia with Bottom of the Sulcus Abnormality . . . . . . . . . . . . . 49
13 Focal Cortical Dysplasia with Gray- White Junction Blurring . . . . . . . . . . . . . . . . 53
14 Focal Cortical Dysplasia with Normal MRI and Abnormal PET . . . . . . . . . . . . . 57
15 Focal Cortical Dysplasia of the Temporal Pole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
16 Focal Cortical Dysplasia of the Amygdala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
17 Diffuse Periventricular Heterotopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
18 Multifocal Periventricular Heterotopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
19 Band Heterotopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
20 Heterotopia Within Cerebral White Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
21 Polymicrogyria Without Schizencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
22 Polymicrogyria with Closed-Lip Schizencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
23 Polymicrogyria with Open Lip Schizencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
24 Lissencephaly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
25 Hemimegalencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
26 Hemimegalencephaly of the Cerebrum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
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27 Encephalocele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
28 Encephalocele After Surgical Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
Part III Trauma
29 Temporal Lobe Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
30 Frontal Lobe Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
31 Bilateral Cerebral Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
32 Multilobar Cerebral Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
Part IV I nfection and Inflammation
33 Acute Herpes Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
34 Remote Herpes Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
35 Acute Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
36 Remote Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
37 GAD65 Autoimmune Limbic Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
38 Voltage Gated Potassium Channel Autoimmune Limbic Encephalitis . . . . . . . . .159
39 NMDA Receptor Autoimmune Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
40 Hashimoto Encephalopathy also Known as Steroid-Responsive
Encephalopathy Associated with Autoimmune Thyroiditis (SREAT) . . . . . . . . . .169
41 Early Stage Rasmussen’s Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
42 Late Stage Rasmussen’s Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Part V Vascular Abnormalities
43 Cavernous Malformation with Acute Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . .185
44 Cavernous Malformation with Resolving Hemorrhage . . . . . . . . . . . . . . . . . . . . .189
45 Cavernous Malformation with Developmental Venous Anomaly . . . . . . . . . . . . . .193
46 Multiple Cavernous Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
47 Arteriovenous Malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
48 Ischemic Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207
49 Porencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
50 Sturge-Weber Syndrome in an Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
51 Sturge-Weber Syndrome in a Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
52 Sturge-Weber Syndrome in an Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
Part VI Tumors
53 Astrocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
54 Oligodendroglioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
55 Dysembryoplastic Neuroepithelial Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243