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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(06): 405-406
DOI: 10.1590/0004-282X20170047
IMAGES IN NEUROLOGY

Epilepsia partialis continua induces transient brain edema

Epilepsia parcial contínua induz edema cerebral transitório
Tiago Silva Aguiar
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Gustavo Lopes de Freitas Honório
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Samila Oliveira Silva
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Renan Amaral Coutinho
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Marcos Martins da Silva
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Cláudia Cecília da Silva Rego
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
2   Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento Neurologia, Rio de Janeiro RJ, Brasil.
,
Marco Antçnio Sales Dantas de Lima
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
,
Soniza Vieira Alves-Leon
1   Universidade Federal do Rio de Janeiro, Faculdade de Medicina,
Hospital Universitário Clementino Fraga Filho, Serviço Neurologia, Departamento de Clínica Médica, Rio de Janeiro RJ, Brasil;
2   Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento Neurologia, Rio de Janeiro RJ, Brasil.
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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]).

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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
Zoom Image
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].

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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

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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