Unusual findings in brain biopsies of two patients with acute magnetic resonance imaging lesions associated with focal seizures

Shearwood McClelland, Jenny M. Libien, Steven S. Chin, David J. Adams, Stanley R. Resor, Stephen Chan, Robert R. Goodman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Patients with focal seizures often have magnetic resonance imaging (MRI) abnormalities in the brain region of their presumed seizure focus. Neoplasms, ischemic infarctions, inflammatory processes, and other specific pathologic entities have been diagnosed by biopsies of such MRI abnormalities. Two patients with this presentation had brain lesion biopsies with a leading presumptive diagnosis of glial neoplasm but were found to have indistinct histopathology. Methods: Each patient was initially seen with focal seizures (right parietal region, right hippocampus) corresponding with focally increased T2 signal on MRI. In both patients, the preoperative clinical suspicion was for neoplastic or inflammatory processes. Results: Several weeks after seizure onset, craniotomy in patient 1 and stereotactic needle biopsy in patient 2 revealed mild gliosis with reactive vascular changes and perivascular hemosiderin deposition, not diagnostic of but compatible with venous congestion (or possibly venous thrombosis). Postoperatively, patient 1 had brief sensory seizures that stopped 5 months after surgery, whereas subsequent seizures did not develop in patient 2. Both patients had normalization of their MRI (except for postoperative changes) and have remained seizure free. Conclusions: We describe two patients who had brain biopsies of striking focal increased T 2 signal MRI abnormalities associated with seizures. Pathologic findings contradicted our preoperative suspicions (neoplasm or inflammatory process), compatible with (but not conclusive for) subacute venous congestion/thrombosis. These findings indicate that patients with seizures may have an associated discrete intraaxial MRI lesion that is not neoplastic. To our knowledge, this is the first report of focal seizure-associated MRI lesions with biopsy findings compatible with venous congestion/thrombosis.

Original languageEnglish
Pages (from-to)1495-1501
Number of pages7
JournalEpilepsia
Volume46
Issue number9
DOIs
StatePublished - Sep 1 2005
Externally publishedYes

Fingerprint

Seizures
Magnetic Resonance Imaging
Biopsy
Brain
Hyperemia
Venous Thrombosis
Hemosiderin
Neoplasms
Parietal Lobe
Gliosis
Craniotomy
Needle Biopsy
Neuroglia
Infarction
Blood Vessels
Hippocampus

Keywords

  • Biopsy
  • Focal epilepsy
  • Magnetic resonance imaging
  • Venous thrombosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

McClelland, S., Libien, J. M., Chin, S. S., Adams, D. J., Resor, S. R., Chan, S., & Goodman, R. R. (2005). Unusual findings in brain biopsies of two patients with acute magnetic resonance imaging lesions associated with focal seizures. Epilepsia, 46(9), 1495-1501. https://doi.org/10.1111/j.1528-1167.2005.07305.x

Unusual findings in brain biopsies of two patients with acute magnetic resonance imaging lesions associated with focal seizures. / McClelland, Shearwood; Libien, Jenny M.; Chin, Steven S.; Adams, David J.; Resor, Stanley R.; Chan, Stephen; Goodman, Robert R.

In: Epilepsia, Vol. 46, No. 9, 01.09.2005, p. 1495-1501.

Research output: Contribution to journalArticle

McClelland, S, Libien, JM, Chin, SS, Adams, DJ, Resor, SR, Chan, S & Goodman, RR 2005, 'Unusual findings in brain biopsies of two patients with acute magnetic resonance imaging lesions associated with focal seizures', Epilepsia, vol. 46, no. 9, pp. 1495-1501. https://doi.org/10.1111/j.1528-1167.2005.07305.x
McClelland, Shearwood ; Libien, Jenny M. ; Chin, Steven S. ; Adams, David J. ; Resor, Stanley R. ; Chan, Stephen ; Goodman, Robert R. / Unusual findings in brain biopsies of two patients with acute magnetic resonance imaging lesions associated with focal seizures. In: Epilepsia. 2005 ; Vol. 46, No. 9. pp. 1495-1501.
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