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AJNR - American Journal of Neuroradiology

Published ahead of print on August 13, 2008
doi: 10.3174/ajnr.A1247

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Excitotoxicity in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion

J. Takanashi^a, H. Tada^a, H. Terada^b and A.J. Barkovich^c

^a Department of Pediatrics, Kameda Medical Center, Kamogawa, Japan
^b Department of Radiology, Toho University Sakura Medical Center, Sakura, Japan
^c Neuroradiology Section, Department of Radiology, University of California, San Francisco, San Francisco, Calif

View larger version (73K): [in this window] [in a new window]   Fig 1. MR imaging and proton MR spectroscopy of patient 1 on days 6 (A–C) and 20 (D, E). A. Axial diffusion-weighted image (SE-EPI: TE = 103, b = 1000) shows a high-signal-intensity lesion in the subcortical white matter, with sparing of the perirolandic region. B, Axial apparent diffusion coefficient map reveals extensive hypointensity, indicating reduced diffusivity, in the subcortical white matter. C, MR spectroscopy (point-resolved spectroscopy sequence [PRESS]: TR/TE/NEX, 5000/30/64; analyzed by LCModel) shows elevated Glx at 2.1–2.5 and 3.8 ppm of 9.2 mmol/L (6.4 ± 0.6 mmol/L) with decreased NAA at 2.0 ppm of 2.5 mmol/L (6.6 ± 0.4 mmol/L). D, Follow-up fluid-attenuated inversion recovery image (TR/TE/TI, 8000/140/2000) shows slight hyperintensity in the periventricular white matter and cerebral cortex with enlarged ventricles and subarachnoid spaces, indicative of mild cerebral atrophy. E, MR spectroscopy (PRESS: TR/TE/NEX, 5000/30/64) at follow-up shows normal Glx of 5.5 mmol/L, markedly decreased NAA of 1.7 mmol/L, and elevated Cho at 3.2 ppm of 1.5 mmol/L.

View larger version (91K): [in this window] [in a new window]   Fig 2. MR imaging and proton MR spectroscopy of patient 3 on days 6 (A, B) and 14 (C, D). A, Axial diffusion-weighted image shows high signal intensity, indicating reduced diffusivity, in the frontal subcortical white matter. B, Proton MR spectroscopy (point-resolved spectroscopy sequence [PRESS]: TR/TE/NEX, 5000/30/64) shows elevated Glx (8.6 mmol/L) with decreased NAA (4.2 mmol/L). C, Follow-up axial diffusion-weighted image shows normalization of diffusion abnormality. D, Follow-up proton MR spectroscopy (PRESS: TR/TE/NEX, 5000/30/64) shows normal Glx of 7.4 mmol/L and near normalization of NAA (5.6 mmol/L).