Late neuroimaging findings after Cryptogenic New Onset Refractory Status Epilepticus: a case report

CALANDRA CRISTIAN; PACHA MARIA SOL; LAGGER IGNACIO; ERNST GLENDA; ORELLANA LUCAS; MARTINEZ OSCAR

Houston

Congreso; 70th American Epilepsy Society Annual Meeting,; 2016

American Epilepsy Society

Rationale: Refractory Status Epilepticus is a severe condition in which seizures do not respond to the first and second line of anticonvulsants. Sometimes it appears suddenly, in patients with no history of epilepsy. This is referred ?new onset refractory status epilepticus? (NORSE). In most cases, the identification of viral agents is performed. However, in some patients, the etiology cannot be identified despite a thorough investigation. These cases are called "cryptogenic". It is controversial whether this entity can generate long-term alterations in brain MRI. Methods: We reported a 22 year- old woman with no history of epilepsy or other important medical disease was admitted with refractory Status Epilepticus 2 years ago. Screening for neoplasias or autoimmune encephalitis antibodies was negative, and the diagnosis of cryptogenic NORSE was done. We made a clinical and neuroimaging follow up for 2 years. Results: We compare the MRI done at that time with another MRI performed 2 years later. MRI at the onset of NORSE showed increased T2 signal in both hippocampi (fig 1). MRI performed 2 years later showed a significant bilateral hippocampi atrophy with a predominance of the right temporal lobe (fig 2). The patients develop a pharmaco- resistance epilepsy after cryptogenic NORSE.Conclusion: In our case, cryptogenic NORSE caused neuroradiological sequelae with severe atrophy in both temporal lobe and pharmaco-resistance epilepsy. Although it is discussed, we suggest that in this case the Status Epilepticus was the cause of structural damage and pharmaco-resistance epilepsy.