Hippocampal Sclerosis

  • Horst Urbach
Part of the Medical Radiology book series (MEDRAD)


Hippocampal sclerosis is by far the most common cause of temporal lobe epilepsy. The familiar reader detects it on MRI in more than 95% of cases but should be aware of typical “pitfalls”, namely bilateral hippocampal sclerosis, “dual pathology” and insufficient image Quality.


Temporal Lobe Epilepsy Epilepsy Surgery Increase Signal Intensity Hippocampal Sclerosis Focal Cortical Dysplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ala TA, Beh GO, Frey WH 2nd (2000) Pure hippocampal sclerosis: a rare cause of dementia mimicking Alzheimer’s disease. Neurology 54:843–848PubMedCrossRefGoogle Scholar
  2. Briellman RS, Kalnins RM, Berkovic SF, Jackson GD (2002) Hippocampal pathology in refractory temporal lobe epilepsy: T2-weighted signal change reflect dentate gliosis. Neurology 58:265–271CrossRefGoogle Scholar
  3. Blümcke I, Thom M, Wiestler OD (2002) Ammon’s horn sclerosis: a maldevelopmental disorder associated with temporal lobe epilepsy. Brain Pathol 12:199–211PubMedGoogle Scholar
  4. Blümcke I, Pauli E, Clusmann H, Schramm J, Becker A, Elger C, Merschhemke M, Meencke HJ, Lehmann T, von Deimling A, Scheiwe C, Zentner J, Volk B, Romstöck J, Stefan H, Hildebrandt M (2007) A new clinico-pathological classification system for mesial temporal sclerosis. Acta Neuropathol 113(3):235–244PubMedCrossRefGoogle Scholar
  5. Blümcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, Jacques TS, Avanzini G, Barkovich AJ, Battaglia G, Becker A, Cepeda C, Cendes F, Colombo N, Crino P, Cross JH, Delalande O, Dubeau F, Duncan J, Guerrini R, Kahane P, Mathern G, Najm I, Ozkara C, Raybaud C, Represa A, Roper SN, Salamon N, Schulze-Bonhage A, Tassi L, Vezzani A, Spreafico R (2011) The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 52:158–174PubMedCrossRefGoogle Scholar
  6. Chan S, Erickson J, Yoon S (1997) Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. RadioGraphics 17:1095–1110PubMedGoogle Scholar
  7. Dickson DW, Davies P, Bevona C, et al (1994) Hippocampal sclerosis: a common pathological feature of dementia in very old (> or = 80 years of age) humans. Acta Neuropathol (Berl) 88:212–221CrossRefGoogle Scholar
  8. Engel J Jr, Van Ness PC, Rasmussen TB, Ojemann LM (1993) Outcome with respect to epileptic seizures. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven Press, New York, pp 609–621Google Scholar
  9. Fauser S, Huppertz HJ, Bast T, Strobl K, Pantazis G, Altenmueller DM, Feil B, Rona S, Kurth C, Rating D, Korinthenberg R, Steinhoff BJ, Volk B, Schulze-Bonhage A (2006) Clinical characteristics in focal cortical dysplasia: a retrospective evaluation in a series of 120 patients. Brain 129:1907–1916PubMedCrossRefGoogle Scholar
  10. Garbelli R, Milesi G, Medici V, Villani F, Didato G, Deleo F, D'Incerti L, Morbin M, Mazzoleni G, Giovagnoli AR, Parente A, Zucca I, Mastropietro A, Spreafico R (2012) Blurring in patients with temporal lobe epilepsy: clinical, high-field imaging and ultra structural study. Brain 135(Pt 8):2337–2349Google Scholar
  11. Hirai T, Korogi Y, Yoshizumi Y, Shigematsu Y, Sugahara T, Takahashi M (2000) Limbic lobe of the human brain: evaluation with turbo fluid-attenuated inversion-recovery MR imaging. Radiology 215:470–475PubMedGoogle Scholar
  12. Howe KL, Dimitri D, Heyn C, Kiehl TR, Mikulis D, Valiante T. Histologically confirmed hippocampal structural features revealed by 3T MR imaging: potential to increase diagnostic specificity of mesial temporal sclerosis. AJNR Am J Neuroradiol 2010 Jun 10Google Scholar
  13. Kobayashi E, Li LM, Lopes-Cendes I, Cendes F (2002) Magnetic resonance imaging evidence of hippocampal sclerosis in asymptomatic, first-degree relatives of patients with familial mesial temporal lobe epilepsy. Arch Neurol 59(12):1891–1894PubMedCrossRefGoogle Scholar
  14. Labate A, Gambardella A, Aguglia U, Condino F, Ventura P, Lanza P, Quattrone A (2010) Temporal lobe abnormalities on brain MRI in healthy volunteers a prospective case-control study. Neurology 74:1CrossRefGoogle Scholar
  15. Levesque MF, Naksato N, Vinters HV et al (1991) Surgical treatment of limbic encephalitis associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 75:364–370PubMedCrossRefGoogle Scholar
  16. Malter MP, Tschampa HJ, Helmstaedter C, Urbach H, von Lehe M, Becker A, Clusmann H, Elger CE, Bien CG (2011) Seizure and memory outcome after epilepsy surgery in patients with bilateral ammon′s horn sclerosis. Ann Neurol (in press)Google Scholar
  17. Margerison JH, Corsellis JAN (1966) Epilepsy and the temporal lobes: a clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes. Brain 89:499–530PubMedCrossRefGoogle Scholar
  18. Menzler K, Iwinska-Zelder J, Shiratori K, Jaeger RK, Oertel WH, Hamer HM, Rosenow F, Knake S (2010) Evaluation of MRI criteria (1.5 T) for the diagnosis of hippocampal sclerosis in healthy subjects. Epilepsy Res 89:349–354PubMedCrossRefGoogle Scholar
  19. Mitchell LA, Harvey AS, Coleman LT, Mandelstam SA, Jackson GD (2003) Anterior temporal changes on MR images of children with hippocampal sclerosis: an effect of seizures on the immature brain? Am J Neuroradiol 24:1670–1677PubMedGoogle Scholar
  20. Nelson PT, Schmitt FA, Lin Y, Abner EL, Jicha GA, Patel E, Thomason PC, Neltner JH, Smith CD, Santacruz KS, Sonnen JA, Poon LW, Gearing M, Green RC, Woodard JL, Van Eldik LJ, Kryscio RJ (2011) Hippocampal sclerosis in advanced age: clinical and pathological features. Brain 134(Pt 5):1506–1518CrossRefGoogle Scholar
  21. Oppenheim C, Dormont D, Biondi A et al (1998) Loss of digitations of the hippocampal head on high-resolution fast spin-echo MR: a sign of mesial temporal sclerosis. AJNR Am J Neuroradiol 19:457–463PubMedGoogle Scholar
  22. Palmini A, Najm I, Avanzini G, Babb T, Guerrini R, Foldvary-Schaefer N, Jackson G, Lüders HO, Prayson R, Spreafico R, Vinters HV (2004) Terminology and classification of the cortical dysplasias. Neurology 62(6 Suppl 3):S2-8. ReviewGoogle Scholar
  23. Schijns OE, Bien CG, Majores M, von Lehe M, Urbach H, Becker AJ, Schramm J, Elger CE, Clusmann H (2011) Temporal gray-white-matter abnormalities are not part of the epileptogenic zone in temporal lobe epilepsy with hippocampal sclerosis. Neurosurgery 68:98–106PubMedCrossRefGoogle Scholar
  24. Soeder BM, Gleissner U, Urbach H, Clusmann H, Vincent A, Bien CG (2009) Causes, presentation and outcome of lesional adult-onset mediotemporal lobe epilepsy. J Neurol Neurosurg Psychiatry 80:894–899PubMedCrossRefGoogle Scholar
  25. Urbach H, Siebenhaar G, Koenig R, von Oertzen J, Scorzin J, Kurthen M, Schild HH (2005) Limbic system abnormalities associated with Ammon’s horn sclerosis do not alter seizure outcome after amygdalohippocampectomy. Epilepsia 46(4):549–555PubMedCrossRefGoogle Scholar
  26. Wiebe S, Blume WT, Girvin JP, Eliasziw M (2001) A randomized, controlled trial of surgery for temporal lobe epilepsy. New Engl J Med 38:154–163Google Scholar
  27. Wieser HG, ILAE Commission on Neurosurgery of Epilepsy (2004) ILAE commission report: mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 45:695–714PubMedCrossRefGoogle Scholar
  28. Wyler AR, Dohan FC, Schweitzer JB, Berry AD (1992) A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy. J Epilepsy 5:220–225CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2013

Authors and Affiliations

  1. 1.Department of NeuroradiologyUniversity Hospital FreiburgFreiburgGermany

Personalised recommendations