Imaging characteristics of temporopolar blurring in the context of hippocampal sclerosis
Clavijo Prado CA, Federico P, Bernasconi A, Bernhardt B, Caciagli L, Concha L, Chinvarun Y, Jackson G, Morgan V, Rampp S, Vaudano AE, Wang I, Wang S, Zaidan BC, Rogerio F, Cendes F (2022)
Publication Type: Journal article
Publication year: 2022
Journal
Book Volume: 24
Pages Range: 1-8
Journal Issue: 1
Abstract
We present an illustrative case to address anterior temporal lobe atrophy with poor delineation of the temporopolar gray-white matter interface based on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images in patients with temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS). A 52-year-old woman with pharmacoresistant seizures since the age of six months underwent a previous MRI scan using a suboptimal protocol which was reported as unremarkable. MRI performed according to an epilepsy protocol showed classic signs of left HS and ipsilateral temporal polar atrophy with blurring of the gray-white matter boundary on FLAIR images. She underwent a left amygdalohippocampectomy and anterior temporal resection and remains seizure-free after 24 months. Histopathological analyses showed HS and no signs of focal cortical dysplasia (FCD). Blurring and atrophy of the ipsilateral temporal pole are common in TLE-HS and often misinterpreted as FCD. This relates to delayed myelination in patients with seizures before the age of two, is more pronounced on FLAIR sequences, and gives a false impression of cortical thickening. However, the T1-weighted images show a relatively well-demarcated cortical-subcortical transition and normal cortical thickness. By contrast, the cortical thickening in FCD is observed on both T1-weighted and FLAIR images. Since FCD also occurs in temporal lobe regions, it is important to differentiate the extra-hippocampal MRI abnormalities in TLE-HS from those likely to be FCD. This case highlights the importance of evaluation based on detailed imaging, which should always be conducted considering the EEG, seizure semiology, and other clinical information.
Authors with CRIS profile
Involved external institutions
Universidade Estadual de Campinas (UNICAMP) / University of Campinas
Brazil (BR)
University of Calgary
Canada (CA)
McConnell Brain Imaging Centre (BIC)
Canada (CA)
University of Pennsylvania
United States (USA) (US)
National Autonomous University of Mexico / Universidad Nacional Autónoma de México (UNAM)
Mexico (MX)
Phramongkutklao Hospital / โรงพยาบาลพระมงกุฎเกล้า
Thailand (TH)
The University of Melbourne
Australia (AU)
Vanderbilt Eye Institute
United States (USA) (US)
Università degli Studi di Modena e Reggio Emilia (UNIMORE)
Italy (IT)
Cleveland Clinic
United States (USA) (US)
Zhejiang University
China (CN)
Brazil (BR)
University of Calgary
Canada (CA)
McConnell Brain Imaging Centre (BIC)
Canada (CA)
University of Pennsylvania
United States (USA) (US)
National Autonomous University of Mexico / Universidad Nacional Autónoma de México (UNAM)
Mexico (MX)
Phramongkutklao Hospital / โรงพยาบาลพระมงกุฎเกล้า
Thailand (TH)
The University of Melbourne
Australia (AU)
Vanderbilt Eye Institute
United States (USA) (US)
Università degli Studi di Modena e Reggio Emilia (UNIMORE)
Italy (IT)
Cleveland Clinic
United States (USA) (US)
Zhejiang University
China (CN)
How to cite
APA:
Clavijo Prado, C.A., Federico, P., Bernasconi, A., Bernhardt, B., Caciagli, L., Concha, L.,... Cendes, F. (2022). Imaging characteristics of temporopolar blurring in the context of hippocampal sclerosis. Epileptic Disorders, 24(1), 1-8. https://dx.doi.org/10.1684/epd.2021.1378
MLA:
Clavijo Prado, Carlos Andrés, et al. "Imaging characteristics of temporopolar blurring in the context of hippocampal sclerosis." Epileptic Disorders 24.1 (2022): 1-8.
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