Artikel
Abnormalities in MRI during non convulsive status mimicking recurrence of glioma
Vortäuschen eines Gliomrezidivs durch Veränderungen im MRT während eines non konvulsiven Status
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Autoren
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K. Franz
- Neurochirurgische Klinik der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
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E. Hattingen
- Institut für Neuroradiologie der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
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S. Weidauer
- Institut für Neuroradiologie der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
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U. Pilatus
- Institut für Neuroradiologie der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
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V. Seifert
- Neurochirurgische Klinik der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
The identification of MRI abnormalities occurring during epileptic seizures is important to distinguish from other neurologic conditions.
Methods
Focal epileptic seizures led to the diagnosis of a left occipital brain tumor in this 24 year old man. After resection of an astrocytoma grade III he received external beam radiation. 12 years later a generalized seizure with postictal aphasia and hemiparesis occurred during a changement of anticonvulsant drugs. The only slow resolution of these postictal symptoms had been interpreted as a Todd-paresis. 5 months later, incomplete aphasia and hemiparesis reappeared and was accompanied by extreme cephalgia.
Results
MRI at the time of incomplete aphasia and hemiparesis showed a contrast enhancement around the ancient resection cavity. The gyral distribution of the contrast medium was as atypical for a recurrent tumor as was the absence of a perifocal edema. 1H MRS showed an increase of the signal of choline in the gyrus angularis and supramarginalis at the lateral border of the resection cavity and in the medial part of the left thalamus. The EEG showed abnormalities suitable with the suspicion of epileptic disorders. A control of MRI some weeks later showed a nearly complete disappearance of the enhancement corresponding with the slow but complete recovery from neurological symptoms in this young man.
Conclusions
Enhancement in MRI during epileptic disorder can lead to the false diagnosis of tumor recurrence. Looking for anamnestic features, attentive clinical observation, electroencephalography combined with control of MRI and 1H MRS will guide to the right diagnosis.
