2017 Volume 39 Issue 6 Pages 446-450
We report the case of an 84-year-old man with mild confusion and aphasia due to nonconvulsive status epilepticus (NCSE), giving special attention to chronological changes in the magnetic resonance imaging (MRI). The emergent diffusion-weighted imaging (DWI) showed slight hyperintensity, and the apparent diffusion coefficient map (ADC-map) showed decreased diffusion in the left pulvinar and hippocampus, which were the suspicious of acute cerebral infarction. Three days after the onset, DWI showed marked hyperintensity in the ipsilateral pulvinar, hippocampus, amygdala, uncus, and cerebral cortex. ADC-map showed combined decreased and increased diffusion. These signal changes indicated vasogenic and/or cytotoxic edema in the acute phase of NCSE. The arterial spin labeling and MR angiography demonstrated ipsilateral regional hyperperfusion. Follow-up MRI showed partial reversible brain damage. These images may reflect chronological changes in the cerebral edema due to hyperperfusion with NCSE.
