General description

Status epilepticus (SE) is a prolonged seizure lasting 30 minutes or more, or a series of seizures occurring so frequently that recovery between episodes is insufficient. It is a clinical emergency associated with significant morbidity and mortality. SE is most common in infants under one year of age and adults over 60.

The condition results from sustained neuronal firing, leading to excessive glutamate release and intracellular calcium influx. These processes contribute to oxidative stress and increased metabolic demands on the brain, causing a relative hypoxic state. Consequently, SE can induce changes in the cerebral cortex similar to those observed in hypoxic encephalopathy.

Radiographic features

T2WI, FLAIR, and DWI show hyperintensity and swelling of the cerebral cortex, sometimes accompanied by diffusion restriction. These imaging features are often reversible but can become irreversible due to prolonged oxidative stress. ASL demonstrates increased perfusion, and MRA reveals dilation of arteries in the corresponding areas.

High signal intensity in the hippocampus and thalamic pulvinar may also be observed on DWI. Additionally, abnormal signals may appear in the contralateral cerebellum, likely caused by abnormal electrical activity transmitted via the corticocerebellar tract.