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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1245-1251, June-July 2006
© 2006 American Society of Neuroradiology

BRAIN

Status Epilepticus as a Risk Factor for Postencephalitic Parenchyma Loss Evaluated by Ventricle Brain Ratio Measurement on MR Imaging

E.K. Herrmann^a,c, K. Hahn^a,d, C. Kratzer^a, I. von Seggern^a, C. Zimmer^b,e and E. Schielke^a,f

^a Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Germany
^b Department of Neuroradiology, Charité, University Medicine Berlin, Campus Mitte, Germany
^c Department of Hematology, Oncology and Tumor Immunology, Robert Rössle Klinik, HELIOS Klinikum Berlin, Charité, University Medicine Berlin, Campus Buch, Germany
^d Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Md
^e Department of Neuroradiology, University of Leipzig, Germany
^f Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany

Please address correspondence to: Eva K. Herrmann, MD, Department of Hematology, Oncology and Tumor Immunology, Robert-Rössle-Klinik, HELIOS Klinikum Berlin, Charité, University Medicine Berlin, Campus Buch, Lindenberger Weg 80, D-13125 Berlin, Germany

BACKGROUND AND PURPOSE: Cerebral atrophy following herpes simplex encephalitis has formerly been described. We aimed to quantify atrophy after encephalitis of various causes. Additional objectives were to define which initial or long-term clinical factors correlate with volume loss and to search for any correlate in global clinical outcome measures.

METHODS: MR imaging was performed in 40 subjects in the acute stage of encephalitis and 6 months after onset of symptoms. The ventricle brain ratio (VBR) was measured on corresponding images from disease onset and follow-up, and the change in VBR (VBR delta) was calculated as a percentage value of the starting measure. Clinical outcome was evaluated by interview and neurologic examination and characterized by using an encephalitis-adapted version of the modified Rankin Scale.

RESULTS: The VBR delta ranged from –5%–102% (median, 5.93%; lower quartile, 1.8%; upper quartile, 14.55%; mean, 14.43%; SD, 23.75%). We found significant differences in the VBR delta between those patients who required intensive care (P = .027), had more than 2 epileptic seizures or a status epilepticus during the acute stage (P = 0.021), or developed postencephalitic epilepsy (P = .015) and their respective counter-subgroups. Three patients were rated to have unfavorable outcome (modified Rankin Scale, 3–5). Patients with unfavorable clinical outcomes tended to show greater VBR delta values, but a statistical evaluation was impossible because of small numbers.

CONCLUSION: More than 2 epileptic seizures or a status epilepticus during the acute stage of encephalitis is associated with a greater loss of parenchyma.