Which IRM séquence ? Young woman, with epilepsie seizure, yo | Figure 1

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Which IRM séquence ? Young woman, with epilepsie seizure, your diagnostic ?

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\ During my EMU rotation, I saw a case I think it is worth reviewing here. Many times, semiology and EEG findings are congruent, however other times they are less clear, so we need to admit pts to our EMU (Epilepsy monitoring Unit) to get a prolonged EEG. This is a 55F, who had this event overnight. On the EPOCH, you can see the onset from the left temporal chains as there is slowing prior to the myogenic artifact. In this case, given the tonic contraction, the myogenic artifact is quite intense that paints all the tracing black. Clinically however, there are a few things you can see, such as head version to the right (this is a lateralizing sign, indicating contralateral onset). and the arms, the flexion of one arm and the dystonic extension of the other arm, it's called "figure of 4" (I personally don't see the "4" but ... anyways).... it's another lateralizing sign that indicates onset contralateral to the dystonic, extended arm. The most important fact we want to get during EMU admission, is the onset. Once the seizure is spread, there is nothing to see on the EEG, as you can see on this example, but prior to this is key, plus the lateralizing signs that you can get, if you are lucky. In this case, given the seizure is nocturnal, a normal, routine EEG would not pick up this. Plus the description of bed partner would not include these lateralizing details, most likely. #loveneurology

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