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Congress: ECR24
Poster Number: C-23296
Type: EPOS Radiologist (scientific)
Authorblock: G. Magro, C. Battaglia, F. Tosto, V. Laterza, O. Di Benedetto; Catanzaro/IT
Disclosures:
Giuseppe Magro: Nothing to disclose
Caterina Battaglia: Nothing to disclose
Federico Tosto: Nothing to disclose
Vincenzo Laterza: Nothing to disclose
Olindo Di Benedetto: Nothing to disclose
Keywords: CNS, MR, Radiobiology, Seizure disorders
Purpose Many reversible brain MRI abnormalities have been described, among these the mostfrequently reported are cortical hyperintensities on FLAIR/T2 occurring during seizures.Much less attention has been given to those situations where White Matter goes Dark. In the most recent review of the literature about seizure-induced brain MRI abnormalities, the “Dark White Matter” sign, or Diffuse Subcortical White Matter Low Intensity on T2/FLAIR, has been reported only once so far. The largest case series on Dark White Matter included 29 patients, the...
Read more Methods and materials PubMed was searched in August 2023.  Articles included were case reports and case series. Results were reviewed and included in the analysis whether a Diffuse Subcortical White Matter Hypointensity on T2/FLAIR was reported. Every article was included based on the title, keywords and full text; referenced articles within the articles were considered too whether they met inclusion criteria. A database of patients was built, every patient was added individually whenever the information was available in the paper or supplementary data....
Read more Results 56 studies were included, 228 patients were eligible for analysis. DWM happened inisolation, with no cortical abnormalities, in 71 cases and was associated with seizures inmore than 61.4% of cases. The most frequently DWM-associated disease was Non-KetoticHyperglycaemic hyperosmolar state (NKH), followed by Encephalitis, Moyamoya disease,Genetic Causes, and Subdural Hematoma. Frequency of NKH was 32%. NKH wasassociated with seizures in 100% of cases and the most frequently involved lobe was theoccipital one. When considering only the subgroup of patients with seizures,...
Read more Conclusion Recognition of DWM is of utmost importance for the neurologist and general practitioner, as this is a frequently missed sign also by expert eyes especially when occurring without cortical involvement. When DWM occurs in the context of seizures NKH is the first etiological process to think of, followed by Encephalitis (mostly anti-MOG). DWM carries diagnostic and therapeutic implications: anti-seizure medication is not the first line of treatment in NKH-associated seizures, but rather the correction of the hyperglycaemic state. Moreover, NKH...
Read more References 1. Cianfoni A, Caulo M, Cerase A, et al. Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol 2013;82(11):1964-72. DOI: 10.1016/j.ejrad.2013.05.020.2.         Xiang T, Li G, Liang Y, Zhou J. A wide spectrum of variably periictal MRI abnormalities induced by a single or a cluster of seizures. J Neurol Sci 2014;343(1-2):167-72. DOI: 10.1016/j.jns.2014.06.001.3.         Kim JA, Chung JI, Yoon PH, et al. Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted...
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