Increased rCBV in status epilepticus


The estimated relative cerebral blood volume (rCBV) is a semiquantitative parameter that correlates with tissue vascularisation. High-grade gliomas are characterised by an increased macrovasculature and microvasculature, and therefore associated with an increased rCBV [1]. In neurooncology, high rCBV is used to distinguish tumoral from non-tumoral increase in lesion size, e.g, pseudoprogression and radiation necrosis from real tumour progression. However, in high-grade glioma an increase in rCBV without tumour progression can also be observed in (nonconvulsive) status epilepticus, as we will describe below. A 45-year-old woman was admitted to our hospital because of a complete paresis of the right arm and motor speech impairment. Thirteen years before she had been treated for an anaplastic oligodendroglioma of the left temporal lobe with surgery followed by radiotherapy (59.4 Gy) and chemotherapy (6 cycles of procarbazine, CCNU, vincristin). Every 6 months a magnetic resonance imaging (MRI) scan of the brain was performed showing a post-surgery cyst and local subtle enhancement, which remained stable over this period (Fig. 1a). Dynamic susceptibility contrast (DSC) perfusion-weighted MR imaging [T2*w gradient echo echo-planar imaging with repetition time of 2,000 ms; 60 phases; contrast bolus injection after 10 phases at 5 ml/s of 12 ml of Gadovist 1.0 (Bayer Schering Pharma) followed by 20 ml 0.9% NaCl; preload bolus of 3 ml of Gadovist 1.0 (Bayer Schering Pharma) 5 min prior to DSC perfusion imaging] performed 5 months before admission showed rCBV ratios of 1.09 (insular L) and 1.18 (occipital L) (Fig. 1d). One week before admission, she had woken up with a headache, a paresis of her right arm and an increased speech impairment. In the following days her headache subsided and her paresis was fluctuating. On admission she showed a mixed aphasia, right hemianopia and a complete paresis of her right arm. An electroencephalogram (EEG) showed clear epileptic discharges located left centroparietal without clinical corresponding symptoms. A MRI scan of the brain showed cortical swelling with extensive cortical enhancement of the left temporal lobe (Fig. 1b), and perfusionweighted imaging showed rCBV ratios of 2.24 (insular L) and 1.64 (occipital L) (Fig. 1e), suggesting tumour progression. The patient was treated with anti-epileptic drugs followed by an improvement of clinical symptoms. A repeat MRI made 2 months later showed a decrease of enhancement (Fig. 1c) and of rCBV ratios (1.07 insular L and 0.78 occipital L) (Fig. 1f) to near-baseline values, indicating the increase in contrast enhancement and rCBV was not due to tumour progression. J. J. G. Rath Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands

DOI: 10.1007/s00415-012-6443-4

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@inproceedings{Rath2012IncreasedRI, title={Increased rCBV in status epilepticus}, author={Judith J. G. Rath and Marion Smits and François Ducray and Martin J. van den Bent}, booktitle={Journal of Neurology}, year={2012} }