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LECTURA DE CASO
Carolina Vargas JiménezRadiodiagnóstico-R2
CAUSAL
LECTURA DE CASO
LECTURA DE CASO
Carolina Vargas JiménezR2- Radiodiagnóstico
CAUSAL
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• ♂ - 17 años• Primer episodio convulsivo EF: Normal• Analítica: NormalEEG – HC: neuropediatría:
- TC ….. EEG: Normal- Episodios de pérdida de la concienciaAlt visual- Síntomas disautonómicos- automatismo ?
HISTORIA CLÍNICA
1. American College of Radiology - ACR Appropriateness Criteria Seizures and Epilepsia
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. American College of Radiology - ACR Appropriateness Criteria Seizures and Epilepsia: Variant 2: New-onset seizure. Unrelated to trauma. Alcohol or drug related.
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- Objetivo:Máximo contraste SB- SG- Protocolo:Axiales: T1- T2 – DWI- GRE Coronales: FLAIR - IRSagital: T1Imagen postcontraste?
EPILEPSIA
Resonancia magnética estructural en la epilepsia. J. Alvarez Linera Prado. Radiología 2012.
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80 % Cuello!
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• Epidemiología: ♀ = - Niños mayores y jóvenes.♂
90% ant. Lesión cerebral precoz10-20% bilateral - Lesión dual
• Cuadro clínico:
Crisis parciales complejas/ aura – 50% generalizanSemiología dependiente de la edadTrastornos de la memoria anterógrada
ESCLEROSIS MESIAL TEMPORAL
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• Asociado a anomalías del desarrollo cortical
ESCLEROSIS MESIAL TEMPORAL
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HIPOCAMPO
ESTUDIO DEL HIPOCAMPO CON RM: anatomía normal, variantes de la normalidad y patología. SERAM 2014.
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Magnetic Resonance Imaging of Mesial Temporal Sclerosis (MTS): What radiologists ought to know? - ECR 2012
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Magnetic Resonance Imaging of Mesial Temporal Sclerosis (MTS): What radiologists ought to know? - ECR 2012
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ESCLEROSIS MESIAL TEMPORAL- TC
- RM: S- E > 95%
- Pérdida neuronal: Atrofia del hipocampo T1- Desestructuración I/R
- Gliosis hipocampo: T2- FLAIR
- Dilatación asta temporal- Atrofia fornix – cuerpo mamilar homolateral - Atrofia- pérdida de definición S. blanca- gris LT- Atrofia talámica y del n. caudado
Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. Radiographics. 17 (5): 1095-110. Chan S, Erickson JK, Yoon SS.
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Esclerosis mesial temporal : un diagnóstico factible con RM convencional. M. Vacas Rodríguez, N. Alegre Borge, P. CARREÑO MORAN, P. Sanchez de Medina Alba, J. F ASENSIO CALLE, S. DE LA MANO. SALAMANCA
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Magnetic Resonance Imaging of Mesial Temporal Sclerosis (MTS): What radiologists ought to know? - ECR 2012
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- Medidas cuantitativas: - Volumetría (93%)- Espectroscopia (97%)
- PET – SPECT : 30 % MRI NORMAL!!
ESCLEROSIS MESIAL TEMPORAL
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ESCLEROSIS MESIAL TEMPORAL• DD: Estatus epiléptico
Astrocitoma de bajo gradoQuiste de la fisura coroideaRemanente del surco hipocampalMalformación cavernosa
• TTO: Médico – Qx si resiste: – Lobectomía temporal - Mejor si MRI (+)– 10% no asocian LCT- peor Rta. QX.– Peor si compromiso amigdalino.
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"la belleza del funcionamiento de las emociones a lo largo de la evolución: permite que los seres vivos reaccionen con inteligencia sin tener que pensar de manera inteligente"