(a) Coronal T2-weighted MR image shows T2 hyperintensity of the right hippocampus (arrow)
(b) On a coronal T2-weighted MR image obtained slightly posterior to a, the white matter of the right temporal pole is T2 hyperintense (arrow) relative to the normal white matter on the left side (arrowhead).
(c) Coronal interictal MR/FDG-PET fusion image shows hypometabolic activity in the right temporal pole (arrow).
Mesial Temporal Sclerosis
"MTS is one of the most common causes of epilepsy in the adolescent and young adult population. At pathologic analysis, it is characterized by neuronal loss with gliosis in the hippocampus and may also involve the ipsilateral fornix and mamillary body . At clinical examination, patients often have a history of a cortical insult such as intracerebral infection, head trauma, or complicated febrile seizures during the first 4–5 years of life . Medical management is usually sufficient initially, and patients may actually become seizure free without medication. When seizures recur, they are usually refractory to medical management . This patient population benefits the most from accurate diagnosis of MTS because surgical therapy offers cure rates near 90% .
The diagnosis of MTS is based on concordance of clinical, electroencephalographic, and imaging data. Characteristic MR imaging features of MTS include atrophy of the hippocampus on T1-weighted images and increased signal intensity in the mesial temporal region on T2-weighted images . However, functional imaging with FDG PET is likely a more sensitive test for hippocampal sclerosis and usually shows an area of hypometabolic activity that is larger than just the hippocampus."
Comments
Post a Comment