Transient Focal MRI Abnormalities after Status Epilepticus Showed 11C-Methionine Uptake with PET in a Patient with Cerebral Cavernous Malformation.

Transient Focal MRI Abnormalities after Status Epilepticus Showed 11C-Methionine Uptake with PET in a Patient with Cerebral Cavernous Malformation.

World Neurosurg. 2018 Mar 09;:

Authors: Ishiguro T, Nitta M, Komori T, Maruyama T, Muragaki Y, Kawamata T

Abstract
BACKGROUND: Transient focal MRI abnormalities after status epilepticus (SE) are rarely seen in patients with benign brain tumors, and the underlying mechanism is still unknown. We report a rare case of cerebral cavernous malformation with transient focal MRI abnormalities around the tumor and accumulation of 11C-methionine on PET after SE. These findings mimicked those of a glioma because the MRI and methionine PET findings were similar. We also speculate about the cause of this phenomenon in relation to pathological findings of this case.
CASE DESCRIPTION: A 51-year-old man suffered from SE. MRI demonstrated a focal T2/FLAIR hyperintense area. 11C-methionine PET showed high accumulation of methionine in the same lesion. The initial diagnosis was low-grade glioma. However, these MRI abnormalities were transient and completely resolved. The patient underwent surgical removal of the tumor, and the histological diagnosis was typical cavernous malformation. Pathological findings of the gyrus around the tumor revealed mild gliosis with proliferating astrocytes, but no evidence of glioma.
CONCLUSIONS: This case suggested that transient focal MRI abnormalities after SE may indicate reversible cortical brain edema. Accumulation of 11C-methionine on PET could occur in the corresponding lesion even if no malignant tumor is present. Because distinguishing transient MRI abnormalities after SE from a glioma is difficult, repeated imaging studies should be performed in patients with brain tumor-related seizures.

PMID: 29530707 [PubMed - as supplied by publisher]

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