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Imaging Abnormalities

Adília Hormigo, MD, PhD; Bernardo Liberato, MD; Eric Lis, MD; Lisa M. DeAngelis, MD

Arch Neurol. 2004;61:362-365.

Background  Convulsive status epilepticus may cause reversible neuroimaging abnormalities. These cortical changes have been reported rarely in association with nonconvulsive status epilepticus.

Objective  To describe patients with cancer who had reversible magnetic resonance (MR) imaging abnormalities from nonconvulsive status epilepticus and whose altered mental status and MR imaging findings were initially considered to result from a structural lesion related to their underlying tumor.

Design  Retrospective study.

Setting  Department of Neurology at Memorial Sloan-Kettering Cancer Center, New York, NY.

Patients  Eight patients with a diagnosis of nonconvulsive status epilepticus who underwent MR imaging.

Results  Enhancing cortical abnormalities were observed on MR images in 4 (50%) of 8 patients with cancer who had impaired mental status and an electroencephalogram demonstrating seizure activity. Follow-up MR images showed neuroimaging improvement or resolution in all patients.

Conclusions  Cortical enhancement on MR images in patients with cancer who have altered mental status may be due to nonconvulsive status epilepticus and not recurrent or metastatic tumor. If electroencephalography is not immediately available at initial evaluation, a trial of anticonvulsant therapy deserves consideration.

From the Departments of Neurology (Drs Hormigo, Liberato, and DeAngelis) and Radiology (Dr Lis), Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University (Drs Hormigo, Liberato, and DeAngelis), New York, NY.

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