Seizures

Q1: What are the common intracranial conditions causing seizures that would benefit from imaging studies?

Generalized convulsive seizures due to recreational drugs or metabolic abnormalities may resolve after treatment of the underlying condition. Focal seizures, or seizures with a focal onset, require a brain MRI with and without contrast to exclude an underlying mass lesion. Since secondary generalization or spread occurs so rapidly, adults with generalized seizures should also have a brain MRI.

Case 1

An 8 y/o, otherwise healthy boy has had generalized tonic-clonic seizures controlled medically for 1 1/2 years, but no brain scans were done. Now his seizures have recurred, and persist despite therapeutic levels of Valproate.

Imaging obtained

MRI revealed large left anterior frontal hemorrhagic lesion with two contiguous foci and surrounding edema. A third lesion in left corona radiata is also seen.
MR angio . Lesion consistent with AVM vs cavernoma.

Case 2

A 66 year-old lady presents with a first episode of a generalized tonic-clonic seizure starting as rhythmical jerking of the arms, neck and face. Post ictally she complained of numbness involving the left upper and lower extremities. 

Are imaging procedures necessary for this patient?  If so, what would you order?

Yes, MRI.

What is your concern?

A mass lesion/tumor causing her seizures, especially in the right cerebral hemisphere.

Partially Calcified Meninigioma

  • A-D: MRI
  • A: Arrow points to punctate low signal on the right side corresponding to calcifications in CT.
  • BCD: Enhancing mass with low signal consistent with partially calcified meningioma involving right fronto-lateral dura.
  • E: CT shows focal calcifications in the site of mass.

66 year-old lady presented with numbness involving the left upper and lower extremities. 

An enhancing (arrows) and partially calcified meningioma (red arrows in A and E) involving the right anterior-lateral frontal dura.