Epilepsia partialis continua induces transient brain edema

A 52-year-old woman with a past history of a tumefactive demyelinating lesion five years ago with left hemiparesis presented with a 30-day history of uninterrupted clonic movements involving her left face and upper limb, compatible with epilepsia partialis continua. An MRI showed right hemispheric cortical swelling ([Figure 1]). She received phenytoin, valproate and phenobarbital with control of the epilepsia partialis continua and resolution of the MRI abnormalities ([Figure 2]).

Figure 1 Brain MRI during epilepsia partialis continua. FLAIR (A) image: right hemispheric increased signal intensity and swelling at the cortical gray matter and subcortical white matter and mild midline shift. DWI (B) and ADC map (C): cortical hyperintensity and restricted diffusion. DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient

Figure 2 Brain MRI two weeks after resolution of the epilepsia partialis continua with antiepileptic drugs. FLAIR (A) image: previous residual aspect of tumefactive demyelinating lesion with hyperintensities in periventricular and subcortical white matter. DWI (B) and ADC map (C) without restricted diffusion. DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient

The reason for cerebral edema in status epilepticus is unknown[1], but restricted cortical diffusion is consistent with cytotoxic edema by cellular energy failure[2],[3]. It can be triggered by an imbalance between the energy supply and demand in neurons and it remains unclear why only certain patients have these abnormalities[1],[3],[4].

Support:

FAPERJ – Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro.

Publication History

Received: 25 August 2016

Accepted: 14 February 2017

Article published online:
05 September 2023

• References

• 1 Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016;38:63-7. https://doi.org/10.1016/j.seizure.2016.04.007
• 2 Hong KS, Cho YJ, Lee SK, Jeong SW, Kim WK, Oh EJ. Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure. 2004;13(5):317-21. https://doi.org/10.1016/j.seizure.2003.08.004
• 3 Chatzikonstantinou A, Gass A, Förster A, Hennerici MG, Szabo K. Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res. 2011;97(1-2):45-51. https://doi.org/10.1016/j.eplepsyres.2011.07.002
• 4 Cartagena AM, Young GB, Lee DH, Mirsattari SM. Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav. 2014;33:24-30. https://doi.org/10.1016/j.yebeh.2014.02.003