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An 82-year-old woman with hypertension and bipolar disorder was admitted with new-onset generalized tonic-clonic seizures. On admission, magnetic resonance imaging (MRI) results were normal and electroencephalography showed right posterior quadrant slowing. She was started on valproic acid. One week later, she was found to have a left hemiparesis and 20 hours of continuous rhythmic jerks of the left leg, arm, and abdomen with retained consciousness, consistent with partial status epilepticus. Magnetic resonance imaging (Figure 1) showed restricted diffusion in the right parietal, occipital, and medial frontal cortices, with corresponding low signal on apparent diffusion coefficient maps. Magnetic resonance angiography results were normal. Electroencephalography (Figure 2) showed right posterior quadrant epileptiform activity that correlated with the area of restricted diffusion. The seizures and hemiparesis resolved after treatment with phenytoin and lorazepam. Repeat MRI 4 weeks later showed resolution of the diffusion abnormality and near-complete resolution of the hyperintensities seen on fluid-attenuated inversion recovery images.
Buracchio T, Lewis SL, Jhaveri M, Bergen D. Restricted Diffusion on Magnetic Resonance Imaging in Partial Status Epilepticus. Arch Neurol. 2008;65(2):278–279. doi:10.1001/archneurol.2007.54
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