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Thread: Left mesial temporal sclerosis case pictures - NEURORADIOLOGY ATLAS

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    Default Left mesial temporal sclerosis case pictures - NEURORADIOLOGY ATLAS

    Febrile seizures
    The relationship, if any, of mesial temporal sclerosis with febrile seizures is controversial, made all the more difficult due to the relative insensitivity of imaging and the difficulty in establishing whether a particular seizure was truly febrile. Up to a third of patients with established refractory temporal lobe epilepsy have a history of seizures in childhood at the time of fever 3. Follow up of children with febrile seizures does not demonstrate significant increased incidence of temporal lobe epilepsy

    Pathology
    The hippocampal formation is not uniformly affected, with the dentate gyrus and the CA1, CA4 and to a lesser degree CA3 sections of the hippocampus being primarily involved. Histologically there is neuronal cell loss, gliosis and sclerosis.

    Aetiology
    Controversy exists as to the causative mechanism: is mesial temporal sclerosis a result of temporal lobe epilepsy or visa versa . In children with newly diagnosed epilepsy, only approximately 1% have evidence of MTS on imaging . Furthermore, in adults 3-10% of cases of mesial temporal sclerosis demonstrate bilateral changes even though symptoms may be unilateral.

    MRI
    MRI is the modality of choice to evaluate the hippocampus, however dedicated TLE protocol needs to be performed if good sensitivity and specificity is to be achieved 5. Thin section angled coronal sequences at right angles to the longitudinal axis of the hippocampus are required, to minimize volume averaging.
    Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose MTS.

    The condition called mesial temporal sclerosis is closely related to temporal lobe epilepsy, a type of partial (focal) epilepsy in which the seizure initiation point can be identified within the temporal lobe of the brain. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated with certain brain injuries. In this patient it was a left sided temporal sclerosis.

    Brain damage from traumatic injury, infection, a brain tumor, a lack of oxygen to the brain, or uncontrolled seizures is thought to cause the scar tissue to form, particularly in the hippocampus, a region of the temporal lobe. The region begins to atrophy; neurons die and scar tissue forms. This damage is thought to be a significant cause of temporal lobe epilepsy. In fact, 70 percent of temporal lobe epilepsy patients have some degree of mesial temporal sclerosis. It also appears that the mesial temporal sclerosis can be worsened by additional seizures.

    SYMPTOMS
    Mesial temporal sclerosis usually results in partial (focal) epilepsy. This seizure disorder can cause a variety of symptoms such as strange sensations, changes in behaviour or emotions, muscle spasms, or convulsions and memory loss. The seizures usually are localized in the brain, but they may spread to become generalized seizures, which involve the entire brain and may cause a sudden loss of awareness or consciousness. Apart from the chronic nature of epilepsy, hippocampal sclerosis was shown to have an important role in internal cardiac autonomic dysfunction. Patients with left hippocampal sclerosis had more severe parasympathetic dysfunction as compared with those with right hippocampal sclerosis. In young individuals, it is commonly recognized as Mesial temporal sclerosis with Temporal Lobe Epilepsy (TLE). On the other hand, it is an often unrecognized cause of cognitive decline, typically presenting with severe memory loss.

    The neurophysician prescribed anti epileptic drugs. For about 6 days the patient took those drugs only to realise that there was no reduction in those uncomfortable symptoms, and now some new symptoms had also come up. He came to me on the 22nd of July 2014 and I asked him to explain in detail what he exactly felt in those 2 -5 minutes.

    This is what he said: –“While in this episode I started to shiver with a feeling of coldness and almost shuddering of only the left side of the body. The hair on my left arm stands up (piloerection), and then a wave like sensation of fluttering originating from left side of chest and moving both up and down on left lower limb and left upper limb and towards the face, also left sided and lacrimation from left eye, and during this time I get that slurred speech if I try to speak. After about 2 to 5 minutes these sensations/episode passes off on its own, only to return aft 20 minutes. During this period, I have a feeling of anxiety and fear also.
    Left mesial temporal sclerosis case attachment.php?s=5c75f7c6754228d55b1644c64215def5&attachmentid=1533&d=1440442567

    During this time the feeling of coldness is so great that I have to cover the left side of my body with a blanket, even though it is the heat of summer, and the right side I leave uncovered. But I am not even able to use the fan, because if I do so, this episode comes earlier than 20 minutes. I used to take alcohol and tobacco products daily but since the day this has started to occur, I have stopped taking them. Also since I am taking these anti-epileptic drugs, that neurologist has given me, now even if a dog barks, I get startled and fearful. I don’t want to hear the sound of T.V. I feel sleepy and miserable after these drugs. My family and I are in great distress, since I have been told by the neurologist that I am not supposed to drive, since I may black out and fall from a scooter or my car may meet an accident under the influence of these anti epileptics drugs.


    The presence of a cystic parenchimatous lesion of neurocysticercosisis associated to inflammatory response, depending on the patient immunological tolerance. It may remain active and present progressive growth, sometimes not associated to clinical manifestation for years1-3.

    When inflammatory response or excessive enlargement of the cyst comes up, there may be many symptoms, including seizures, headache or focal neurological deficits. The CSF may be normal or show only mild protein elevation, but pleocytosis with presence of eosinophilus and a positive ELISA or immunofluorescence test is commonly observed.

    The treatment with cysticids (albendazole or praziquantel) in most patients accelerate the degeneration of cysts and improve clinical symptoms3,4, but this remains controversial1. Neurocysticercosis and seizures are common and its relationship is more clearly identified in patients with adult onset partial seizures, frequently associated to headache or focal neurological deficits. The correlation between cyst localization and seizure semiology is variable, as well as the correlation between number of cysts and seizure frequency.

    The recent advances on neuroimaging have provided means for better evaluating patients with epilepsy, particularly those with refractory seizures or suspected structural abnormalities. New MRI techniques have allowed a more detailed evaluation of cystic lesions, inflammatory response (observed as the presence of edema or gadolinium enhancement) and associated abnormalities6.

    The presence of hippocampal atrophy (HA) associated with altered internal structure and increased T2 signal is an "in vivo" MRI evidence of mesial temporal sclerosis (MTS)7. MTS is a particular pathological finding, observed more than a century ago, with a specific pattern of neuronal loss on subfields of hippocampal formation and other medial temporal structures8. It has been associated to prolonged febrile seizures and recurrent seizures, but the relationship of repeated seizures and HA remains uncertain9.

    The co-existence of HA and neurocysticercosis has been demonstrated, mainly in patients with calcified lesions and history of temporal lobe epilepsy (TLE), with early seizure onset and refractory epilepsy. As TLE is the most frequent form of partial epilepsy and neurocysticercosis is highly prevalent among our patients, these calcifications are thought to have an innocent role in the clinical outcome of these patients.

    We describe in this report the early finding of MRI evidence of MTS in a patient with new onset complex partial seizures (CPS) after acute neurocysticercosis, and we discuss the possible mechanisms in the development of hippocampal pathology.

    References:
    Arquivos de Neuro-Psiquiatria - Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report
    Mesial Temporal Sclerosis - Symptoms Reversed with Homoeopathy - Clinical Cases - Hpathy.com
    Mesial temporal sclerosis | Radiology Reference Article | Radiopaedia.org











    Last edited by Medical Photos; 08-24-2015 at 06:56 PM.

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