Status epilepticus (SE) is a clinical entity characterized by one continuous, unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 5 minutes. In the peri-ictal phase MR may show sign of hyperperfusion in the seizure focus and adjacent areas.

We observed 4 patients affected by SE both in the post-ictal an in the delayed time with MR, Diffusion-weighted MR imaging (DW-MRI) and MR-Angiography and we correlated imaging with EEG results to find possible impairments of cerebral circulation and correlate them with morphological alterations.

In this case series on patients without previous records of epileptic seizures, MR was proved useful in the identification of transient DWI and FLAIR signal abnormalities suggestive for hyperperfusion, of the thalamic involvement in the seizure genesis or propagation and of the hippocampal sparing, as well as in the differential diagnosis with pathological conditions causing seizures. Delayed MR scans were diriment for the exclusion of cerebral damage due to cytotoxic edema. While MRA provided interesting diagnostic information, abnormalities consistent with hyperperfusion having always been observed,...

Further studies on larger samples and with different imaging techniques (e.g. perfusional MR or CT perfusion), could provide a more accurate relation between pre- and post-ictal CBF modifications, its adequateness, and the implication of these data in the prognostic and therapeutic process of patients affected by epilepsy.

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