mesial temporal sclerosis radiology

Methods: Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). Chan S, Erickson JK, Yoon SS. Final diagnosis:  mesial temporal sclerosis, ADVERTISEMENT: Supporters see fewer/no ads. When assessing this condition coronal T2 small FOV images are ideal to assess the hippocampus. Histologically there is neuronal cell loss, gliosis and sclerosis. Fast Fluid-Attenuated Inversion Recovery (FLAIR) Compared with T2-Weighted Spin-Echo in the Magnetic Resonance Diagnosis of Mesial Temporal Sclerosis Investigative Radiology, Vol. Procedure guideline for brain perfusion SPECT using technetium-99m radiopharmaceuticals. In children with newly diagnosed epilepsy, only ~ 1% have evidence of MTS on imaging 3. Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines. 17 (5): 1095-110. Mesial temporal sclerosis (MTS)is the most common association with intractable temporal lobe epilepsy (TLE). It is seen in up to 65% of autopsy studies, although significantly less on imaging. Assessment of the Preferred Plane and Sequence in the Depiction of Mesial Temporal Sclerosis Using Magnetic Resonance Imaging INVESTIGATIVE RADIOLOGY, Vol. Radiology. From the case: Mesial temporal sclerosis MRI T2 The right hippocampus is markedly smaller than the left with loss of the normal internal architecture and diffuse T2 high signal which involves the body and tail. TLE is initially managed medically with anti-epileptic agents. The radiology information system data base was surveyed for the term “mesial temporal sclerosis” during a 53-month period (between January 2009 and May 2013) to find patients who had MR imaging studies. 820 Jorie Blvd., Suite 200 Oak Gadolinium is not required 5. Camacho DL, Castillo M. MR imaging of temporal lobe epilepsy. 4. 7. In this patient with chronic seizure disorder, we see volume less of the right hippocampus with distortion of the normal morphology, increased T2/FLAIR hyperintensity, and … Ultrasound CT MR. 2007;28 (6): 424-36. Conversely, due to neuronal dysfunction and swelling, diffusion is restricted following a seizure, and thus values are lower 5. Most patients present with complex partial temporal lobe epilepsy. Sections of the mesial structures confirm mesial temporal sclerosis, which is represented by a profound depletion of neurones within CA1. Although the etiology of MTS remains controversial, there is now a considerable … ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Mesial temporal lobe epilepsy is the most common form of human epilepsy, and its pathophysiological substrate is usually hippocampal sclerosis, the most common epileptogenic lesion encountered in patients with epilepsy. This case illustrates a typical clinical presentation followed by characteristic MRI features for hippocampal atrophy and further treatment and pathology confirmation. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1664,"mcqUrl":"https://radiopaedia.org/articles/mesial-temporal-sclerosis/questions/341?lang=us"}. Asymmetry of the mesial temporal lobes suggesting left mesial temporal sclerosis. The patient had been on multiple seizure medications in thepast. Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). The lesion most commonly reported in surgical and autopsy series of mesial TLE is hippocampal sclerosis (HS), although temporal lobe encephalomalacia, neoplasia, vascular malformations, and developmental malformations often occur in patients with TLE (2–4). Epilepsy Curr. Esclerosis temporal mesial Mesial temporal sclerosis Oscar F. Valdivieso C.ª*, Verónica Mota G.,ª Ana L. Velasco M., b Esteban Figueroa P., c y José Luis Criales C.ª ª … 1998;19 (1): 15-8. MR spectroscopy findings typically represent neuronal dysfunction 5: MR perfusion demonstrates similar changes to SPECT (see below) with blood perfusion depending on when the scan is obtained. Radiology. J Neurosurg Pediatr. We included 46 Sections of the mesial structures confirm mesial temporal sclerosis, which is represented by a profound depletion of neurones within CA1. 1. Although comparing left to right side is easiest, it must be remembered that up to 10% of cases are bilateral, and thus if symmetry is the only feature being evaluated, many cases may be misinterpreted as normal. 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 4. The volumes and signal intensity … Subpial gliosis is evident. Anterior temporal lobectomy is successful in 75-90% of patients with MTS. Semin. Access to this article can also be purchased. If anything, care must be taken not to allow an enlarged horn to trick you into thinking the hippocampus is reduced in size. Most patients present with complex partial temporal lobe epilepsy. This article requires a subscription to view the full text. 8. Neuroradiology Case of the Week Case 105 from University of Rochester cases. Imaging: 15% bilateral, atrophy of hippocampus / amygdala / fornix / mamillary body. A localised aggregate of neurocytic cells is observed, equivalent to focal microdysgenesis. 3. Shinnar S. Febrile Seizures and Mesial Temporal Sclerosis. 2006;66 (4): 562-5. Thin section angled coronal sequences at right angles to the longitudinal axis of the hippocampus are required, to minimize volume averaging. Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study. 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. Unable to process the form. Juni JE1, Waxman AD, Devous MD Sr, Tikofsky RS, Ichise M, Van Heertum RL, Holman BL, Carretta RF, Chen CC. 34, No. The hallmark of mesial temporal sclerosis on MR imaging is an atrophic hippocampus associated with hyperintense signal on long-repetition-time se- quences confined to the hippocampus (5–10). To assess imaging, clinical, and pathological features of mesial temporal lobe epilepsy (mTLE) patients with amygdala enlargement (AE) in comparison with those with mesial temporal sclerosis (MTS). 28-year-old male with a long-standing history of seizures localizing to the inferomedial right temporal lobe on EEG. Mesial temporal sclerosis (MTS), which involves neuronal loss and gliosis within the mesial temporal structures (primarily in Sommer sector and the CA4 region of the hippocampus), 1 is an important cause of temporal lobe epilepsy. No other diagnostic neuropathologic findings are seen. The radiology information system data base was surveyed for the term “mesial temporal sclerosis” during a 53-month period (between January 2009 and May 2013) to find patients who had MR imaging studies. Mesial temporal sclerosis: Diagnosis with fluid-attenuated inversion-recovery versus spin-echo MR imaging. 2 MRI Techniques for the Identification of Neuronal Migration Disorders Purpose To improve diagnosis of hippocampal sclerosis (HS) in patients with mesial temporal lobe epilepsy (MTLE) by using MR fingerprinting and compare with visual assessment of T1- and T2-weighted MR images. 1996 May;199(2):367-373. A localised aggregate of neurocytic cells is observed, equivalent to focal microdysgenesis. Often mentioned, but probably one of the least specific findings, is enlargement of the temporal horn of the lateral ventricle 5. 1998 May;39(5):923-6. Mesial temporal sclerosis D H Jogi MB BCh, FCRad (Diag) (SA), FRCR (Lond) N17 East Rand Private Community Hospital Springs M Patel MB ChB, FCRad (Diag) (SA) Department of Radiology Chris Hani Baragwanath Hospital Complex partial seizures and mesial temporal sclerosis: evaluation with fast spin-echo MR imaging. 5 Long-Term Follow-Up of Patients Treated Surgically for Medically Intractable Epilepsy: Results in 291 Patients Treated at Mayo Clinic Rochester Between July 1972 and March 1985 The mesial temporal lobe epilepsy (MTLE) is highly refractory to pharmacological treatment [], and it is the main group of epilepsy referred to the tertiary care hospitals for surgical treatment []. SPECT (Tc-99m HMPAO or ECD)9 and PET (F18-FDG) imaging are also a useful adjuncts, with both ictal and interictal scans demonstrating abnormalities: Other causes of temporal lobe epilepsy (TLE) should be considered, especially as small temporal lobe cortical tumors can have similar appearances. Mesial temporal sclerosis (MTS) is a specific pattern of hippocampal neuronal loss accompanied by gliosis and atrophy. Jack CR, Rydberg CH, Krecke KN, Trenerry MR, Parisi JE, Rydberg JN et al. Ammon horn sclerosis—defined as loss of pyramidal neurons predominantly in the cornu ammon… In five patients with mesial temporal sclerosis, the authors verified the precision and reproducibility of hippocampal segmentations with deformation-based magnetic resonance (MR) imaging. {"url":"/signup-modal-props.json?lang=gb\u0026email="}. Tarkka R, Pääkkö E, Pyhtinen J et-al. Etiology: controversial: is it result of temporal lobe epilepsy or vice versa. Mesial temporal sclerosis (MTS) is a common pathologic finding in patients with temporal lobe epilepsy. In interictal periods, conversely, perfusion is reduced 5. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Mesial Temporal Sclerosis Toxic, Metabolic, … Follow up of children with febrile seizures does not demonstrate signifi… 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. 2003;3 (4): 115-118. The etiology is unknown, but there is a relationship between MTS and prolonged febrile seizures earlier in life, complicated delivery and developmental processes. Rarely MTS can be detected in children during the first decade of life, but is not commonly found until adolescence. Also diffuse cerebellar atrophy, which is likely secondary When severe and long standing, additional associated findings include 4: Additional 3D volumetric studies can be performed, and although time consuming to post-process may be more sensitive to subtle hippocampal volume loss. Society of Nuclear Medicine. Check for errors and try again. 2012;9 (5): 552-61. Bronen R. MR of mesial temporal sclerosis: how much is enough? Sections of the mesial structures show extensive mesial temporal sclerosis, represented by neuronal loss in sector CA1, with less mild neuronal loss in sectors CA3 … 2003;60 (2): 215-8. Interesting Radiology Cases from Daily Practice and a Personal Reference Thursday, May 6, 2010 Mesial Temporal Sclerosis Posted by Radiologist at 11:24 AM Email This BlogThis! 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 3. Kasasbeh A, Hwang EC, Steger-May K et-al. Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association w… | Radiology, Temporal lobe epilepsy, Epilepsy Apr 2, 2017 - Left temporal lobe atrophy including extensive sclerosis of the hippocampus consistent with a structural cause for epilepsy. MRI: T2 hyperintense. One feature of MTS is hippocampal volume loss. T2 relaxometry may also be useful in detecting cases of hippocampal sclerosis 5. 6. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. During the peri-ictal phases, perfusion is increased, not only in the mesial temporal lobe but often in large parts of temporal lobe and hemisphere. MTLE shows a good surgical prognosis, with satisfactory seizures control in 60–80% of the patients [ 3 ]. Association of magnetic resonance imaging identification of mesial temporal sclerosis with pathological diagnosis and surgical outcomes in children following epilepsy surgery. Controversy exists as to the causative mechanism: is mesial temporal sclerosis a result of temporal lobe epilepsy or vice versa 5? Subpial gliosis is evident. Unable to process the form. Primer - Neuroradiology - Congenital Diseases. Detecting mesial temporal sclerosis (MTS) is important for the evaluation of patients with temporal lobe epilepsy as it often guides surgical intervention. Furthermore, in adults 3-10% of cases of mesial temporal sclerosis demonstrate bilateral changes 5 even though symptoms may be unilateral. MESIAL TEMPORAL SCLEROSIS The term mesial temporal sclerosis signifies scarring and volume loss of medial temporal structures: the hippocampus, the amygdala, and the parahippocampal gyrus (including the entorhinal cortex). The patient went on to have a hippocampectomy. These findings, atrophy and hyperintensity, are often re- ferred to as the two primary MR findings of mesial temporal sclerosis. 9. 1993 Dec;189(3):835-42. Focal hippocampal dysfunction initiates electrophysiologic seizures and impairs interictal cognition in patients with mesial temporal lobe epilepsy (TLE) (1). J Nucl Med. As a result of neuronal loss, the extracellular space is enlarged and thus diffusion of water molecules is greater on the affected side, resulting in increased values on the affected side (higher signal on ADC). Alternate names … MRI evidence of mesial temporal sclerosis in sporadic "benign" temporal lobe epilepsy. The disabling seizures associated with mesial temporal lobe epilepsy are typical … 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. May 18, 2015 - Typical appearances of mesial temporal sclerosis. No other diagnostic neuropathologic findings are seen. Hippocampal sclerosis (Redirected from Mesial temporal sclerosis) Hippocampal sclerosis (HS) is a neuropathological condition with severe neuronal cell loss and gliosis in the hippocampus, specifically in the CA-1 (Cornu Ammonis area 1) and subiculum of the hippocampus. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Labate A, Ventura P, Gambardella A et-al. Check for errors and try again. Selected images demonstrate a small right hippocampus with increased T2 signal consistent with right-sided mesial temporal sclerosis. If you have a subscription you may use the login form below to view the article. Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy (TLE) 2,3,5. -. Mesial Temporal Sclerosis. All o… Typical appearances of mesial temporal sclerosis. Neurology. A 6-year-old boy with a 5-year history of intractable complexpartial seizure was referred by his neurologist for a presurgicalevaluation of a brain locus that may have triggered the seizures.The seizures were described as starting with vocalizations thatwould quickly convert to convulsions of all four extremities.Afterward, the patient would become aphasic or dysarthric forapproximately 1 minute; then the patient would become sleepy. In patients who are refractory to medical management temporal lobectomy or selective amygdalohippocampectomy may be performed. Materials and PET FDG: low metabolism. Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose MTS. This case was donated to Radiopaedia.org by Radswiki.net Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines. 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. AJNR Am J Neuroradiol. abnormal morphology: loss of internal architecture (interdigitations of hippocampus), increased signal and or atrophy of the anterior thalamic nucleus, increased signal and/or reduction in the volume of the, dilatation of temporal horn and temporal lobe atrophy, collateral white matter and entorhinal cortex atrophy, loss of grey-white matter interface in the anterior temporal lobe, decreased NAA and decreased NAA/Cho and NAA/Cr ratios, decreased MI in ipsilateral temporal lobe, increased lipid  and lactate soon after as seizure. 5. It was first described in 1880 by Wilhelm Sommer. 1. Objective: To search for [18 F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). 2. Purpose: To assess imaging, clinical, and pathological features of mesial temporal lobe epilepsy (mTLE) patients with amygdala enlargement (AE) in comparison with those with mesial temporal sclerosis (MTS). Neurology. 32, No. Dysembryoplastic neuroepithelial tumor (DNET), reduced hippocampal volume: hippocampal atrophy. Radiographics. Here in this case there's a typical appearance of mesial temporal sclerosis in the form of reduced size of the right hippocampus with increased signal on T2 and FLAIR images. Follow up of children with febrile seizures does not demonstrate significant increased incidence of lobe... Gambardella a et-al selective amygdalohippocampectomy may be performed cells is observed, equivalent to focal microdysgenesis is temporal! Imaging INVESTIGATIVE RADIOLOGY, Vol 5 even though symptoms may be unilateral of neurones within CA1 Asymmetry! 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Increased incidence of temporal lobe epilepsy as it No longer meets image preparation and/or other case publication guidelines RADIOLOGY Vol... Swelling, diffusion is restricted following a seizure, and thus values are lower 5 pathological diagnosis and surgical in! Hippocampus / amygdala / fornix / mamillary body to the causative mechanism: is mesial temporal.. Is not commonly found until adolescence mtle shows a good surgical mesial temporal sclerosis radiology, with seizures. Fornix / mamillary body and Sequence in the cornu ammon… Asymmetry of the temporal horn the! Values are lower 5 in interictal periods, conversely, perfusion is reduced 5 is. Of temporal lobe epilepsy as it often guides surgical intervention at right angles to the longitudinal axis of mesial! In 60–80 % of patients with temporal lobe epilepsy you have a subscription to view the.! A model of chronic cerebral changes due to seizures in patients with temporal lobe 3. Subscription you may use the login form below to view the full text camacho DL, M.! Result of temporal lobe epilepsy specific findings, atrophy of hippocampus / amygdala / fornix / body. The causative mechanism: is mesial temporal sclerosis demonstrate bilateral changes 5 even though symptoms be. And thus values are lower 5 Using technetium-99m radiopharmaceuticals multiple seizure medications in thepast secondary 1 temporal lobectomy successful... Vice versa 5 et al depletion of neurones within CA1 autopsy studies, significantly!

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