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Status Epilepticus
Miral D. Jhaveri, MD, MBA; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Status epilepticus (SE)
            • Synonyms

              • Transient seizure-related MR changes, reversible postictal cerebral edema
            • Definitions

              • Seizure with ≥ 5 minutes continuous clinical &/or electrographic seizure activity, or recurrent seizure activity without recovery between seizures
              • MR changes associated with seizures likely related to transient cerebral edema

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Husari KS et al: New-onset refractory status epilepticus in children: etiologies, treatments, and outcomes. Pediatr Crit Care Med. 21(1):59-66, 2020
                                            2. Guerriero RM et al: Imaging modalities to diagnose and localize status epilepticus. Seizure. 68:46-51, 2019
                                            3. Sculier C et al: New onset refractory status epilepticus (NORSE). Seizure. 68:72-8, 2019
                                            4. Strohm T et al: FDG-PET and MRI in the evolution of new-onset refractory status epilepticus. AJNR Am J Neuroradiol. 40(2):238-44, 2019
                                            5. Meletti S et al: Neuroimaging of status epilepticus. Epilepsia. 59 Suppl 2:113-9, 2018
                                            6. Betjemann JP et al: Status epilepticus in adults. Lancet Neurol. 14(6):615-24, 2015
                                            7. Cartagena AM et al: Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav. 33:24-30, 2014
                                            8. Ohe Y et al: MRI abnormality of the pulvinar in patients with status epilepticus. J Neuroradiol. 41(4):220-6, 2014
                                            9. Di Bonaventura C et al: Diffusion-weighted magnetic resonance imaging in patients with partial status epilepticus. Epilepsia. 50 Suppl 1:45-52, 2009
                                            10. Goyal MK et al: Peri-ictal signal changes in seven patients with status epilepticus: interesting MRI observations. Neuroradiology. 51(3):151-61, 2009
                                            11. Katramados AM et al: Periictal diffusion abnormalities of the thalamus in partial status epilepticus. Epilepsia. 50(2):265-75, 2009
                                            12. Masterson K et al: Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol. 36(1):48-51, 2009
                                            13. Milligan TA et al: Frequency and patterns of MRI abnormalities due to status epilepticus. Seizure. 18(2):104-8, 2009
                                            14. Nair PP et al: Role of cranial imaging in epileptic status. Eur J Radiol. 70(3):475-80, 2009
                                            15. Buracchio T et al: Restricted diffusion on magnetic resonance imaging in partial status epilepticus. Arch Neurol. 65(2):278-9, 2008
                                            16. Goyal MK et al: Role of MR imaging in the evaluation of etiology of status epilepticus. J Neurol Sci. 272(1-2):143-50, 2008
                                            17. Provenzale JM et al: Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis. AJR Am J Roentgenol. 190(4):976-83, 2008
                                            18. Yu JT et al: Diffusion-weighted magnetic resonance imaging demonstrates parenchymal pathophysiological changes in epilepsy. Brain Res Rev. 59(1):34-41, 2008
                                            19. Kuster GW et al: Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study. Arq Neuropsiquiatr. 65(4B):1101-4, 2007
                                            20. Parmar H et al: Acute symptomatic seizures and hippocampus damage: DWI and MRS findings. Neurology. 66(11):1732-5, 2006
                                            21. Calistri V et al: Visualization of evolving status epilepticus with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol. 24(4):671-3, 2003
                                            22. Hicdonmez T et al: Reversible postictal MRI change mimicking structural lesion. Clin Neurol Neurosurg. 105(4):288-90, 2003
                                            23. Oster J et al: Diffusion-weighted imaging abnormalities in the splenium after seizures. Epilepsia. 44(6):852-4, 2003
                                            24. Cohen-Gadol AA et al: Transient postictal magnetic resonance imaging abnormality of the corpus callosum in a patient with epilepsy. Case report and review of the literature. J Neurosurg. 97(3):714-7, 2002
                                            25. Amato C et al: Transient MRI abnormalities associated with partial status epilepticus: a case report. Eur J Radiol. 38(1):50-4, 2001
                                            26. Castillo M et al: Proton MR spectroscopy in patients with acute temporal lobe seizures. AJNR Am J Neuroradiol. 22(1):152-7, 2001
                                            27. Kim JA et al: Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol. 22(6):1149-60, 2001
                                            28. Polster T et al: Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry. 70(4):459-63, 2001
                                            29. Sagiuchi T et al: Transient seizure activity demonstrated by Tc-99m HMPAO SPECT and diffusion-weighted MR imaging. Ann Nucl Med. 15(3):267-70, 2001
                                            30. Men S et al: Selective neuronal necrosis associated with status epilepticus: MR findings. AJNR Am J Neuroradiol. 21(10):1837-40, 2000
                                            31. Kim SS et al: Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol. 20(1):125-9, 1999
                                            32. Aykut-Bingol C et al: Reversible MRI lesions after seizures. Seizure. 6(3):237-9, 1997
                                            33. Chan S et al: Reversible signal abnormalities in the hippocampus and neocortex after prolonged seizures. AJNR Am J Neuroradiol. 17(9):1725-31, 1996
                                            34. Cox JE et al: Seizure-induced transient hippocampal abnormalities on MR: correlation with positron emission tomography and electroencephalography. AJNR Am J Neuroradiol. 16(8):1736-8, 1995
                                            35. Wasterlain CG et al: Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 34 Suppl 1:S37-53, 1993
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Status epilepticus (SE)
                                                      • Synonyms

                                                        • Transient seizure-related MR changes, reversible postictal cerebral edema
                                                      • Definitions

                                                        • Seizure with ≥ 5 minutes continuous clinical &/or electrographic seizure activity, or recurrent seizure activity without recovery between seizures
                                                        • MR changes associated with seizures likely related to transient cerebral edema

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Husari KS et al: New-onset refractory status epilepticus in children: etiologies, treatments, and outcomes. Pediatr Crit Care Med. 21(1):59-66, 2020
                                                                                      2. Guerriero RM et al: Imaging modalities to diagnose and localize status epilepticus. Seizure. 68:46-51, 2019
                                                                                      3. Sculier C et al: New onset refractory status epilepticus (NORSE). Seizure. 68:72-8, 2019
                                                                                      4. Strohm T et al: FDG-PET and MRI in the evolution of new-onset refractory status epilepticus. AJNR Am J Neuroradiol. 40(2):238-44, 2019
                                                                                      5. Meletti S et al: Neuroimaging of status epilepticus. Epilepsia. 59 Suppl 2:113-9, 2018
                                                                                      6. Betjemann JP et al: Status epilepticus in adults. Lancet Neurol. 14(6):615-24, 2015
                                                                                      7. Cartagena AM et al: Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav. 33:24-30, 2014
                                                                                      8. Ohe Y et al: MRI abnormality of the pulvinar in patients with status epilepticus. J Neuroradiol. 41(4):220-6, 2014
                                                                                      9. Di Bonaventura C et al: Diffusion-weighted magnetic resonance imaging in patients with partial status epilepticus. Epilepsia. 50 Suppl 1:45-52, 2009
                                                                                      10. Goyal MK et al: Peri-ictal signal changes in seven patients with status epilepticus: interesting MRI observations. Neuroradiology. 51(3):151-61, 2009
                                                                                      11. Katramados AM et al: Periictal diffusion abnormalities of the thalamus in partial status epilepticus. Epilepsia. 50(2):265-75, 2009
                                                                                      12. Masterson K et al: Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol. 36(1):48-51, 2009
                                                                                      13. Milligan TA et al: Frequency and patterns of MRI abnormalities due to status epilepticus. Seizure. 18(2):104-8, 2009
                                                                                      14. Nair PP et al: Role of cranial imaging in epileptic status. Eur J Radiol. 70(3):475-80, 2009
                                                                                      15. Buracchio T et al: Restricted diffusion on magnetic resonance imaging in partial status epilepticus. Arch Neurol. 65(2):278-9, 2008
                                                                                      16. Goyal MK et al: Role of MR imaging in the evaluation of etiology of status epilepticus. J Neurol Sci. 272(1-2):143-50, 2008
                                                                                      17. Provenzale JM et al: Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis. AJR Am J Roentgenol. 190(4):976-83, 2008
                                                                                      18. Yu JT et al: Diffusion-weighted magnetic resonance imaging demonstrates parenchymal pathophysiological changes in epilepsy. Brain Res Rev. 59(1):34-41, 2008
                                                                                      19. Kuster GW et al: Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study. Arq Neuropsiquiatr. 65(4B):1101-4, 2007
                                                                                      20. Parmar H et al: Acute symptomatic seizures and hippocampus damage: DWI and MRS findings. Neurology. 66(11):1732-5, 2006
                                                                                      21. Calistri V et al: Visualization of evolving status epilepticus with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol. 24(4):671-3, 2003
                                                                                      22. Hicdonmez T et al: Reversible postictal MRI change mimicking structural lesion. Clin Neurol Neurosurg. 105(4):288-90, 2003
                                                                                      23. Oster J et al: Diffusion-weighted imaging abnormalities in the splenium after seizures. Epilepsia. 44(6):852-4, 2003
                                                                                      24. Cohen-Gadol AA et al: Transient postictal magnetic resonance imaging abnormality of the corpus callosum in a patient with epilepsy. Case report and review of the literature. J Neurosurg. 97(3):714-7, 2002
                                                                                      25. Amato C et al: Transient MRI abnormalities associated with partial status epilepticus: a case report. Eur J Radiol. 38(1):50-4, 2001
                                                                                      26. Castillo M et al: Proton MR spectroscopy in patients with acute temporal lobe seizures. AJNR Am J Neuroradiol. 22(1):152-7, 2001
                                                                                      27. Kim JA et al: Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol. 22(6):1149-60, 2001
                                                                                      28. Polster T et al: Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry. 70(4):459-63, 2001
                                                                                      29. Sagiuchi T et al: Transient seizure activity demonstrated by Tc-99m HMPAO SPECT and diffusion-weighted MR imaging. Ann Nucl Med. 15(3):267-70, 2001
                                                                                      30. Men S et al: Selective neuronal necrosis associated with status epilepticus: MR findings. AJNR Am J Neuroradiol. 21(10):1837-40, 2000
                                                                                      31. Kim SS et al: Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol. 20(1):125-9, 1999
                                                                                      32. Aykut-Bingol C et al: Reversible MRI lesions after seizures. Seizure. 6(3):237-9, 1997
                                                                                      33. Chan S et al: Reversible signal abnormalities in the hippocampus and neocortex after prolonged seizures. AJNR Am J Neuroradiol. 17(9):1725-31, 1996
                                                                                      34. Cox JE et al: Seizure-induced transient hippocampal abnormalities on MR: correlation with positron emission tomography and electroencephalography. AJNR Am J Neuroradiol. 16(8):1736-8, 1995
                                                                                      35. Wasterlain CG et al: Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 34 Suppl 1:S37-53, 1993