Jalal Jalal Shokouhi – MD Editor in Chief of Iranian Society of Radiology Imaging of epilepsis

Seizure is the clinical manifestations of an abnormal and excessive excitation of a population of neurons in the brain. Epilepsy is recurrent on provoked seizures.

Etiology of seizures and epilepsy is idiopathic cryptogenic in 65.5%, Vascular 10.9%, congenital 8%, Traumatic 5.5%, neoplastic 4.1%, degenerative 3.5%, and infectious 2.5% (hauser wa,et al).

Risk factors for epilepsy that imaging can show them, are: Head injuries in military and civilian populations, Stroke, Embolic risk factors, left ventricular hypertrophy, Encephalitis, Bacterial meningitis, Aseptic meningitis, Alzheimer disease, multiple sclerosis, Alcohol, Heroin and Marijuana intoxication.

For treatment control, also also imaging could be in plan.

Conclusion: Although EEG is the most specific test for diagnosis but MRI is the imaging tool of choice, especially in partial epilepsy.

PET, SPECT, MEG are important for localization of seizure focus often used in pre-surgical evaluations.

Epilepsy diagnosis  Clinic  EEG, Brain mapping  CT, CTA  MRI, MRA, MRV  Magnetography  Mulecular, Spect, Pet

CT and MRI in Epilepsy

Pathology and causes: 1.Developmental disorders Neuronal migration disorders Hamartomas Vascular malformations,… Neuronal migration disorders include the following: 1.Tuberous sclerosis 2.Focal cortical dysplasias 3.Polymicrogyria 4.Schizencephaly 5.Heterotopias 6.Lissencephaly (agyria-pachygria) 7.Hemimegalencephaly 8.Microdysgenesis

GREY MATTER HETEROTOPIA, BAND HETEROTOPIA, NODULAR SUBEPANDIMAL

VASCULAR ANOMALY, PARIETAL TEMPORAL AND OCCIPITAL

ENHANCED VASCULAR ANOMALYBILATERAL SCHIZENCEPHALIC CLEFTS CLEFT IN SAGITAL

 2.Traumatic Hematomas, foreign bodies, penetrating injuries, depressed fractures, brain edema, …Hematomas, foreign bodies, penetrating injuries, depressed fractures, brain edema, …  3.Vascular, hemorrhagic and ischemic Cerebrovascular disease, including stroke, porencephaly, …Cerebrovascular disease, including stroke, porencephaly, …

SITES OF TRAUMATIC LESIONS

HEMATOMAS

ANEURYSM

ANEURYSMS

VASCULAR ANOMALY

ISCHEMIC & HEMORRHAGIC

VASCULAR ANOMALY

ISCHEMIC CHANGES

4.Neoplasms GliomasGliomas Mixed neuronoglial tumorsMixed neuronoglial tumors Dysembryoplastic neuroepithelial tumorDysembryoplastic neuroepithelial tumor OthersOthers5.Infections Infections (bacterial, viral, fungal, parasitic diseases) &Infections (bacterial, viral, fungal, parasitic diseases) & Immune-mediated disorders (Rasmussen`s syndrome)Immune-mediated disorders (Rasmussen`s syndrome) 6.Mesial temporal sclerosis(hippocampus)

SPECT, HYPER PERFUSION 12 SECONDS AFTER EPILEPSIES, TRACER WAS INJECTED

HIPPOCAMPAL ATROPHY, MESIAL TEMPORAL SCLEROSIS

ASTROCYTOMA IN THE RIGHT MESIAL TEMPORAL LOBE COVERNOUS HEMANGIOMA IN THE RIGHT MESIAL TEMPORAL LOBE

DURAL BASED MENINGIOMA WITH CALCIFICATION

Cysticercosis+hydatid

A NEOPLASM

ANOTHER NEOPLASM WITH SEVERE EDEMA AND MIDLINE SHIFT

A HUGE SIZED NEOPLASM WITH BILATERAL EDEMA

HIPPOCAMPUS MESIAL TEMPORAL SCLEROSIS

LEFT FRONTAL AND TEMPORAL HYPOMETABOLISM IN A: TEMPORAL LOBE EPILEPSY PET. CRONAL SPECT- HMPAO SCAN SHOWING: INCREASED PERFUSION IN THE LEFT FRONTAL LOBE IN RASMUSSEN`S ENCEPHALITIS+ HYPERPERFUSION IN AXIAL Axial Coro

Epilepsy induced by atrophy