Use of diffusion-weighted imaging to distinguish seizure-related change from limbic encephalitis
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Use of diffusion‑weighted imaging to distinguish seizure‑related change from limbic encephalitis Adrian Budhram1,2 · Jeffrey W. Britton1 · Greta B. Liebo3 · Divyanshu Dubey1,4 · Anastasia Zekeridou1,4 · Eoin P. Flanagan1,4 · Andrew McKeon1,4 · Sean J. Pittock1,4 · Sherri A. Braksick1 · Nicholas L. Zalewski1 Received: 10 April 2020 / Revised: 14 June 2020 / Accepted: 17 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To determine whether diffusion-weighted imaging (DWI) can help differentiate peri-ictal signal abnormality from limbic encephalitis (LE) among patients with medial temporal lobe T2-hyperintensity. Methods We retrospectively identified patients with peri-ictal medial temporal lobe T2-hyperintensity using a Mayo Clinic database, and reviewed their DWI to look for unique diffusion restriction patterns. We then identified patients with medial temporal lobe T2-hyperintensity and LE, and reviewed their DWI to see if these patterns were ever present. Presence of diffusion restriction patterns was confirmed by a blinded neuro-radiologist. Results We identified 10 patients without LE who had peri-ictal unilateral medial temporal lobe T2-hyperintensity, ipsilateral to focal seizure onset. Nine of 10 (90%) had at least one of two diffusion restriction patterns potentially unique to seizure activity; four had gyriform hippocampal diffusion restriction (“Pattern 1”), three had diffuse hippocampal diffusion restriction that spared the most medial temporal lobe structures (“Pattern 2”), and two had both diffusion restriction patterns. The median patient age was 62 years (range 2–76 years) and 3/9 (33%) were female. In comparison, among patients with medial temporal lobe T2-hyperintensity and LE, only 5/57 (9%) had one of the diffusion restriction patterns (“Pattern 2”) identified (P
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