1993 Dec;189(3):835-42. Often mentioned, but probably one of the least specific findings, is enlargement of the temporal horn of the lateral ventricle 5. In interictal periods, conversely, perfusion is reduced 5. Detecting mesial temporal sclerosis (MTS) is important for the evaluation of patients with temporal lobe epilepsy as it often guides surgical intervention. Shinnar S. Febrile Seizures and Mesial Temporal Sclerosis. Subpial gliosis is evident. Association of magnetic resonance imaging identification of mesial temporal sclerosis with pathological diagnosis and surgical outcomes in children following epilepsy surgery. T2 relaxometry may also be useful in detecting cases of hippocampal sclerosis 5. 2003;3 (4): 115-118. All o… SPECT (Tc-99m HMPAO or ECD)9 and PET (F18-FDG) imaging are also a useful adjuncts, with both ictal and interictal scans demonstrating abnormalities: Other causes of temporal lobe epilepsy (TLE) should be considered, especially as small temporal lobe cortical tumors can have similar appearances. Juni JE1, Waxman AD, Devous MD Sr, Tikofsky RS, Ichise M, Van Heertum RL, Holman BL, Carretta RF, Chen CC. Mesial temporal sclerosis (MTS), which involves neuronal loss and gliosis within the mesial temporal structures (primarily in Sommer sector and the CA4 region of the hippocampus), 1 is an important cause of temporal lobe epilepsy. Histologically there is neuronal cell loss, gliosis and sclerosis. When severe and long standing, additional associated findings include 4: Additional 3D volumetric studies can be performed, and although time consuming to post-process may be more sensitive to subtle hippocampal volume loss. In children with newly diagnosed epilepsy, only ~ 1% have evidence of MTS on imaging 3. Here in this case there's a typical appearance of mesial temporal sclerosis in the form of reduced size of the right hippocampus with increased signal on T2 and FLAIR images. Mesial temporal lobe epilepsy is the most common form of human epilepsy, and its pathophysiological substrate is usually hippocampal sclerosis, the most common epileptogenic lesion encountered in patients with epilepsy. Primer - Neuroradiology - Congenital Diseases. Gadolinium is not required 5. Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy (TLE) 2,3,5. Rarely MTS can be detected in children during the first decade of life, but is not commonly found until adolescence. The radiology information system data base was surveyed for the term “mesial temporal sclerosis” during a 53-month period (between January 2009 and May 2013) to find patients who had MR imaging studies. Neurology. Mesial temporal sclerosis (MTS)is the most common association with intractable temporal lobe epilepsy (TLE). Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). Selected images demonstrate a small right hippocampus with increased T2 signal consistent with right-sided mesial temporal sclerosis. Focal hippocampal dysfunction initiates electrophysiologic seizures and impairs interictal cognition in patients with mesial temporal lobe epilepsy (TLE) (1). This case was donated to Radiopaedia.org by Radswiki.net Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines. MESIAL TEMPORAL SCLEROSIS The term mesial temporal sclerosis signifies scarring and volume loss of medial temporal structures: the hippocampus, the amygdala, and the parahippocampal gyrus (including the entorhinal cortex). Thin section angled coronal sequences at right angles to the longitudinal axis of the hippocampus are required, to minimize volume averaging. 1. 2012;9 (5): 552-61. Dysembryoplastic neuroepithelial tumor (DNET), reduced hippocampal volume: hippocampal atrophy. 820 Jorie Blvd., Suite 200 Oak Interesting Radiology Cases from Daily Practice and a Personal Reference Thursday, May 6, 2010 Mesial Temporal Sclerosis Posted by Radiologist at 11:24 AM Email This BlogThis! 6. We included 46 The relationship, if any, of mesial temporal sclerosis with febrile seizures is controversial, made all the more difficult due to the relative insensitivity of imaging and the difficulty in establishing whether a particular seizure was truly febrile. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The relationship, if any, of mesial temporal sclerosis with febrile seizures is controversial, made all the more difficult due to the relative insensitivity of imaging and the difficulty in establishing whether a particular seizure was truly febrile. J Neurosurg Pediatr. MRI: T2 hyperintense. The patient went on to have a hippocampectomy. Up to a third of patients with established refractory temporal lobe epilepsy have a history of seizures in childhood at the time of fever 3. abnormal morphology: loss of internal architecture (interdigitations of hippocampus), increased signal and or atrophy of the anterior thalamic nucleus, increased signal and/or reduction in the volume of the, dilatation of temporal horn and temporal lobe atrophy, collateral white matter and entorhinal cortex atrophy, loss of grey-white matter interface in the anterior temporal lobe, decreased NAA and decreased NAA/Cho and NAA/Cr ratios, decreased MI in ipsilateral temporal lobe, increased lipid  and lactate soon after as seizure. Bronen R. MR of mesial temporal sclerosis: how much is enough? Subpial gliosis is evident. Radiographics. No other diagnostic neuropathologic findings are seen. This article requires a subscription to view the full text. 7. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. The hallmark of mesial temporal sclerosis on MR imaging is an atrophic hippocampus associated with hyperintense signal on long-repetition-time se- quences confined to the hippocampus (5–10). Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association w… | Radiology, Temporal lobe epilepsy, Epilepsy Apr 2, 2017 - Left temporal lobe atrophy including extensive sclerosis of the hippocampus consistent with a structural cause for epilepsy. In five patients with mesial temporal sclerosis, the authors verified the precision and reproducibility of hippocampal segmentations with deformation-based magnetic resonance (MR) imaging. Asymmetry of the mesial temporal lobes suggesting left mesial temporal sclerosis. Final diagnosis:  mesial temporal sclerosis, ADVERTISEMENT: Supporters see fewer/no ads. Tarkka R, Pääkkö E, Pyhtinen J et-al. TLE is initially managed medically with anti-epileptic agents. 5 Long-Term Follow-Up of Patients Treated Surgically for Medically Intractable Epilepsy: Results in 291 Patients Treated at Mayo Clinic Rochester Between July 1972 and March 1985 The lesion most commonly reported in surgical and autopsy series of mesial TLE is hippocampal sclerosis (HS), although temporal lobe encephalomalacia, neoplasia, vascular malformations, and developmental malformations often occur in patients with TLE (2–4). MRI evidence of mesial temporal sclerosis in sporadic "benign" temporal lobe epilepsy. If you have a subscription you may use the login form below to view the article. Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1664,"mcqUrl":"https://radiopaedia.org/articles/mesial-temporal-sclerosis/questions/341?lang=us"}. The disabling seizures associated with mesial temporal lobe epilepsy are typical … Mesial temporal sclerosis D H Jogi MB BCh, FCRad (Diag) (SA), FRCR (Lond) N17 East Rand Private Community Hospital Springs M Patel MB ChB, FCRad (Diag) (SA) Department of Radiology Chris Hani Baragwanath Hospital May 18, 2015 - Typical appearances of mesial temporal sclerosis. 2006;66 (4): 562-5. Ammon horn sclerosis—defined as loss of pyramidal neurons predominantly in the cornu ammon… 28-year-old male with a long-standing history of seizures localizing to the inferomedial right temporal lobe on EEG. In this patient with chronic seizure disorder, we see volume less of the right hippocampus with distortion of the normal morphology, increased T2/FLAIR hyperintensity, and … The hippocampal formation is not uniformly affected, with the dentate gyrus, and the CA1, CA4 and to a lesser degree CA3 sections of the hippocampus being primarily involved 4. Mesial temporal sclerosis (MTS) is a specific pattern of hippocampal neuronal loss accompanied by gliosis and atrophy. Kasasbeh A, Hwang EC, Steger-May K et-al. MTLE shows a good surgical prognosis, with satisfactory seizures control in 60–80% of the patients [ 3 ]. 9. Objective: To search for [18 F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). Purpose: To assess imaging, clinical, and pathological features of mesial temporal lobe epilepsy (mTLE) patients with amygdala enlargement (AE) in comparison with those with mesial temporal sclerosis (MTS). It is seen in up to 65% of autopsy studies, although significantly less on imaging. Procedure guideline for brain perfusion SPECT using technetium-99m radiopharmaceuticals. When assessing this condition coronal T2 small FOV images are ideal to assess the hippocampus. Mesial temporal sclerosis: Diagnosis with fluid-attenuated inversion-recovery versus spin-echo MR imaging. 5. Controversy exists as to the causative mechanism: is mesial temporal sclerosis a result of temporal lobe epilepsy or vice versa 5? -. Epilepsy Curr. Etiology: controversial: is it result of temporal lobe epilepsy or vice versa. 1998;19 (1): 15-8. Imaging: 15% bilateral, atrophy of hippocampus / amygdala / fornix / mamillary body. These findings, atrophy and hyperintensity, are often re- ferred to as the two primary MR findings of mesial temporal sclerosis. Hippocampal sclerosis (Redirected from Mesial temporal sclerosis) Hippocampal sclerosis (HS) is a neuropathological condition with severe neuronal cell loss and gliosis in the hippocampus, specifically in the CA-1 (Cornu Ammonis area 1) and subiculum of the hippocampus. Chan S, Erickson JK, Yoon SS. 2 MRI Techniques for the Identification of Neuronal Migration Disorders {"url":"/signup-modal-props.json?lang=gb\u0026email="}. Check for errors and try again. 8. Jack CR, Rydberg CH, Krecke KN, Trenerry MR, Parisi JE, Rydberg JN et al. PET FDG: low metabolism. Up to a third of patients with established refractory temporal lobe epilepsy have a history of seizures in childhood at the time of fever 3. Although the etiology of MTS remains controversial, there is now a considerable … Unable to process the form. In patients who are refractory to medical management temporal lobectomy or selective amygdalohippocampectomy may be performed. Esclerosis temporal mesial Mesial temporal sclerosis Oscar F. Valdivieso C.ª*, Verónica Mota G.,ª Ana L. Velasco M., b Esteban Figueroa P., c y José Luis Criales C.ª ª … Neurology. The etiology is unknown, but there is a relationship between MTS and prolonged febrile seizures earlier in life, complicated delivery and developmental processes. MR spectroscopy findings typically represent neuronal dysfunction 5: MR perfusion demonstrates similar changes to SPECT (see below) with blood perfusion depending on when the scan is obtained. The mesial temporal lobe epilepsy (MTLE) is highly refractory to pharmacological treatment [], and it is the main group of epilepsy referred to the tertiary care hospitals for surgical treatment []. Alternate names … Purpose To improve diagnosis of hippocampal sclerosis (HS) in patients with mesial temporal lobe epilepsy (MTLE) by using MR fingerprinting and compare with visual assessment of T1- and T2-weighted MR images. Although comparing left to right side is easiest, it must be remembered that up to 10% of cases are bilateral, and thus if symmetry is the only feature being evaluated, many cases may be misinterpreted as normal. The patient had been on multiple seizure medications in thepast. Check for errors and try again. 17 (5): 1095-110. Also diffuse cerebellar atrophy, which is likely secondary It was first described in 1880 by Wilhelm Sommer. Ultrasound CT MR. 2007;28 (6): 424-36. J Nucl Med. Methods: Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). Sections of the mesial structures confirm mesial temporal sclerosis, which is represented by a profound depletion of neurones within CA1. A 6-year-old boy with a 5-year history of intractable complexpartial seizure was referred by his neurologist for a presurgicalevaluation of a brain locus that may have triggered the seizures.The seizures were described as starting with vocalizations thatwould quickly convert to convulsions of all four extremities.Afterward, the patient would become aphasic or dysarthric forapproximately 1 minute; then the patient would become sleepy. During the peri-ictal phases, perfusion is increased, not only in the mesial temporal lobe but often in large parts of temporal lobe and hemisphere. Assessment of the Preferred Plane and Sequence in the Depiction of Mesial Temporal Sclerosis Using Magnetic Resonance Imaging INVESTIGATIVE RADIOLOGY, Vol. The radiology information system data base was surveyed for the term “mesial temporal sclerosis” during a 53-month period (between January 2009 and May 2013) to find patients who had MR imaging studies. Materials and If anything, care must be taken not to allow an enlarged horn to trick you into thinking the hippocampus is reduced in size. Most patients present with complex partial temporal lobe epilepsy. Follow up of children with febrile seizures does not demonstrate significant increased incidence of temporal lobe epilepsy 3. 4. Complex partial seizures and mesial temporal sclerosis: evaluation with fast spin-echo MR imaging. 1996 May;199(2):367-373. 1. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Mesial Temporal Sclerosis Toxic, Metabolic, … Radiology. AJNR Am J Neuroradiol. 3. Most patients present with complex partial temporal lobe epilepsy. Unable to process the form. Society of Nuclear Medicine. Anterior temporal lobectomy is successful in 75-90% of patients with MTS. Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose MTS. Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines. Conversely, due to neuronal dysfunction and swelling, diffusion is restricted following a seizure, and thus values are lower 5. A localised aggregate of neurocytic cells is observed, equivalent to focal microdysgenesis. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2003;60 (2): 215-8. 1998 May;39(5):923-6. The volumes and signal intensity … 32, No. 2. One feature of MTS is hippocampal volume loss. Labate A, Ventura P, Gambardella A et-al. Typical appearances of mesial temporal sclerosis. Neuroradiology Case of the Week Case 105 from University of Rochester cases. Furthermore, in adults 3-10% of cases of mesial temporal sclerosis demonstrate bilateral changes 5 even though symptoms may be unilateral. Follow up of children with febrile seizures does not demonstrate signifi… 34, No. From the case: Mesial temporal sclerosis MRI T2 The right hippocampus is markedly smaller than the left with loss of the normal internal architecture and diffuse T2 high signal which involves the body and tail. MRI is the modality of choice to evaluate the hippocampus, however dedicated TLE protocol needs to be performed if good sensitivity and specificity is to be achieved 5. Sections of the mesial structures confirm mesial temporal sclerosis, which is represented by a profound depletion of neurones within CA1. No other diagnostic neuropathologic findings are seen. Access to this article can also be purchased. Semin. A localised aggregate of neurocytic cells is observed, equivalent to focal microdysgenesis. Sections of the mesial structures show extensive mesial temporal sclerosis, represented by neuronal loss in sector CA1, with less mild neuronal loss in sectors CA3 … Mesial Temporal Sclerosis. Camacho DL, Castillo M. MR imaging of temporal lobe epilepsy. This case illustrates a typical clinical presentation followed by characteristic MRI features for hippocampal atrophy and further treatment and pathology confirmation. Radiology. Fast Fluid-Attenuated Inversion Recovery (FLAIR) Compared with T2-Weighted Spin-Echo in the Magnetic Resonance Diagnosis of Mesial Temporal Sclerosis Investigative Radiology, Vol. Mesial temporal sclerosis (MTS) is a common pathologic finding in patients with temporal lobe epilepsy. 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