What is the role of MRI in the workup of status epilepticus (SE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Brain MRI is rarely indicated in the acute phase of generalized convulsive SE. Although MRI provides more information than CT, it is more time consuming, and the additional information rarely affects immediate treatment and evaluation.

In contrast, in a patient with simple partial SE that does not match previous seizures, the search for an epileptic focus should include brain imaging, preferably with MRI (or CT if MRI is unavailable) to look for a new lesion (eg, new stroke, mass lesion). Currently, many centers offer advanced MRI, such as diffusion-weighted, perfusion, and susceptibility-weighted imaging. [61] These newer methods can be particularly helpful in identifying acute cerebral ischemia.

Nevertheless, MRIs may be problematic in focal SE because the SE itself can cause a wide range of MRI abnormalities, many of which are transient. Repeat imaging over weeks to months may be helpful to clarify their interpretation.


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