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PICTURES IN CLINICAL MEDICINE
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Crossed Cerebellar and Contralateral Thalamic Hyperperfusion in Epilepsy Yuki Takane, Koichi Shibata, Yoshiko Nishimura and Hiroshi Sakura Key words: crossed cerebellar hyperperfusion, arterial spin-labeling, epilepsy, status epilepticus, periodic lateralized epileptiform discharges, thalamus
(Intern Med 56: 1121-1122, 2017) (DOI: 10.2169/internalmedicine.56.7632)
Picture.
A 59-year-old man with no history of seizure, who was undergoing treatment for chronic alcoholic cirrhosis, was admitted for a fever due to cellulitis and alcohol withdrawal. A generalized seizure with left facial twitching developed after the patient lost consciousness during status epilepticus (SE).
Electroencephalogram showed periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere (Picture A). The seizure stopped after intravenous administration of midazolam. Three days after SE onset, arterial spinlabeling perfusion magnetic resonance imaging, a noninva-
Department of Medicine, Tokyo Women’s Medical University Medical Center East, Japan Received for publication April 27, 2016; Accepted for publication August 28, 2016 Correspondence to Dr. Koichi Shibata, [email protected]
1121
Intern Med 56: 1121-1122, 2017
DOI: 10.2169/internalmedicine.56.7632
sive method of assessing the cerebral blood flow, showed hyperintense areas in the right frontal, temporal, and parietal cortices; the left thalamus (Picture B and C); and the cerebellum (Picture D). Hyperperfusions in the ipsilateral thalamus and contralateral cerebellum to the epileptic cortex have been reported (1), but our case is the first report of its presence in the contralateral thalamus. Abnormal thalamic perfusion in generalized SE might reflect propagation of ictal activity to the contralateral side of the epileptic focus in the periictal stage (2).
References 1. Matsuura K, Maeda M, Okamoto K, et al. Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy. J Neurol Sci 359: 424-429, 2015. 2. Chatzikonstantinou A, Gass A, Förster A, Hennerici MG, Szabo K. Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45-51, 2011. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
The authors state that they have no Conflict of Interest (COI).
Ⓒ 2017 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
1122
PICTURES IN CLINICAL MEDICINE
□
Crossed Cerebellar and Contralateral Thalamic Hyperperfusion in Epilepsy Yuki Takane, Koichi Shibata, Yoshiko Nishimura and Hiroshi Sakura Key words: crossed cerebellar hyperperfusion, arterial spin-labeling, epilepsy, status epilepticus, periodic lateralized epileptiform discharges, thalamus
(Intern Med 56: 1121-1122, 2017) (DOI: 10.2169/internalmedicine.56.7632)
Picture.
A 59-year-old man with no history of seizure, who was undergoing treatment for chronic alcoholic cirrhosis, was admitted for a fever due to cellulitis and alcohol withdrawal. A generalized seizure with left facial twitching developed after the patient lost consciousness during status epilepticus (SE).
Electroencephalogram showed periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere (Picture A). The seizure stopped after intravenous administration of midazolam. Three days after SE onset, arterial spinlabeling perfusion magnetic resonance imaging, a noninva-
Department of Medicine, Tokyo Women’s Medical University Medical Center East, Japan Received for publication April 27, 2016; Accepted for publication August 28, 2016 Correspondence to Dr. Koichi Shibata, [email protected]
1121
Intern Med 56: 1121-1122, 2017
DOI: 10.2169/internalmedicine.56.7632
sive method of assessing the cerebral blood flow, showed hyperintense areas in the right frontal, temporal, and parietal cortices; the left thalamus (Picture B and C); and the cerebellum (Picture D). Hyperperfusions in the ipsilateral thalamus and contralateral cerebellum to the epileptic cortex have been reported (1), but our case is the first report of its presence in the contralateral thalamus. Abnormal thalamic perfusion in generalized SE might reflect propagation of ictal activity to the contralateral side of the epileptic focus in the periictal stage (2).
References 1. Matsuura K, Maeda M, Okamoto K, et al. Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy. J Neurol Sci 359: 424-429, 2015. 2. Chatzikonstantinou A, Gass A, Förster A, Hennerici MG, Szabo K. Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res 97: 45-51, 2011. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
The authors state that they have no Conflict of Interest (COI).
Ⓒ 2017 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
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