Status Epilepticus

  • Silvana Sarria-EstradaEmail author
  • Manuel Toledo
Living reference work entry


The early detection of status epilepticus is a key factor to reduce mortality and long-term consequences. Overall, computed tomography (CT) is the most relevant tool to define the etiologic diagnosis in the acute situation. Magnetic resonance imaging (MRI) increases the specificity, with diffusion-weighted imaging (DWI) and T2-weighted imaging, showing signal alterations in certain cerebral areas, suggestive of status epilepticus (hippocampus, thalamus, cortical regions, and cerebellum). The use of perfusion techniques with either CT or MR may lead to identification of focal hyperperfusion regions matching the epileptogenic sources during the status epilepticus. Finally, in the long-term follow-up, MR can show the potential consequences of the status epilepticus, like mesial temporal sclerosis or focal cortical atrophy.


Epilepsy Status epilepticus Imaging Neuroradiology Seizures Perfusion Diffusion Magnetic resonance imaging (MRI) Computed tomography (CT) 



Apparent diffusion coefficient


Blood-brain barrier


Central nervous system


Computed tomography


Diffusion-weighted imaging




Febrile infection-related epilepsy syndrome


Magnetic resonance imaging


New-onset refractory status epilepticus


Posterior reversible encephalopathy syndrome


Perfusion-weighted imaging


  1. Betjemann JP, Lowenstein DH. Status Epilepticus in adults. Lancet Neurol. 2015;14:615–24.CrossRefGoogle Scholar
  2. Gelfand JM, Wintermark M, Josephson SA. Cerebral perfusion-CT patterns following seizure. Eur J Neurol. 2010;17:594–601.CrossRefGoogle Scholar
  3. Glaser CA, Gilliam S, Honarmand S, Tureen JH, Lowenstein DH, Anderson LJ, et al. Refractory status epilepticus in suspect encephalitis. Neurocrit Care. 2008;9:74–82.CrossRefGoogle Scholar
  4. Gorter JA, van Vliet EA, Aronica E. Status epilepticus, blood-brain barrier disruption, inflammation, and epileptogenesis. Epilepsy Behav. 2015;49:13–6.CrossRefGoogle Scholar
  5. Hauf M, Slotboom J, Nirkko A, von Bredow F, Ozdoba C, Wiest R. Cortical regional hyperperfusion in nonconvulsive status epilepticus measured by dynamic brain perfusion CT. AJNR Am J Neuroradiol. 2009;30:693–8.CrossRefGoogle Scholar
  6. Hocker S, Nagarajan E, Rabinstein AA, Hanson D, Britton JW. Progressive brain atrophy in super-refractory status epilepticus. JAMA Neurol. 2016;73:1201–7.CrossRefGoogle Scholar
  7. Jabeen SA, Cherukuri P, Mridula R, Harshavardhana KR, Gaddamanugu P, Sarva S, et al. A prospective study of diffusion weighted magnetic resonance imaging abnormalities in patients with cluster of seizures and status epilepticus. Clin Neurol Neurosurg. 2017;155:70–4.CrossRefGoogle Scholar
  8. Mathews MS, Smith WS, Wintermark M, Dillon WP, Binder DK. Local cortical hypoperfusion imaged with CT perfusion during postictal Todd’s paresis. Neuroradiology. 2008;50:397–401.CrossRefGoogle Scholar
  9. Meletti S, Giovanni G, d’Orsi G, Toran L, Monti G, Guha R, et al. New-onset refractory status epilepticus with claustrum damage: definition of the clinical and neuroimaging features. Front Neurol. 2017;8:111.CrossRefGoogle Scholar
  10. Meletti S, Monti G, Mirandola L, Vaudano AE, Giovannini G. Neuroimaging of status epilepticus. Epilepsia. 2018;59(Suppl 2):113–9.CrossRefGoogle Scholar
  11. Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016;38:63–7.CrossRefGoogle Scholar
  12. Milligan TA, Zamani A, Bromfield E. Frequency and patterns of MRI abnormalities due to status epilepticus. Seizure. 2009;18:104–8.CrossRefGoogle Scholar
  13. Toledo M, Munuera J, Sueiras M, Rovira R, Alvarez-Sabín J, Rovira A. MRI findings in aphasic status epilepticus. Epilepsia. 2008;49:1464–9.CrossRefGoogle Scholar
  14. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus – report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56:1515–23.CrossRefGoogle Scholar

Suggested Readings

  1. Bar-Klein G, Lublinsky S, Kamintsky L, Noyman I, Veksler R, Dalipaj H. Imaging blood-brain barrier dysfunction as a biomarker for epileptogenesis. Brain. 2017;140:1692–705.CrossRefGoogle Scholar
  2. Fujikawa DG. Prolonged seizures and cellular injury: understanding the connection. Epilepsy Behav. 2005;7(Suppl 3):S3–11.CrossRefGoogle Scholar
  3. Sutter R, Semmlack S, Kaplan PW. Nonconvulsive status epilepticus in adults- insights into the invisible. Nat Rev Neurol. 2016;12:281–93.CrossRefGoogle Scholar
  4. Szabo K, Poepel A, Pohlmann-Eden B, Hirsch J, Back T, Sedlaczek O, Hennerici M, Gass A. Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain. 2005;128:1369–76.CrossRefGoogle Scholar
  5. Van Cauwenberge MGA, Dekeyzer S, Nikoubashman O, Dafotakis M, Wiesmann M. Can perfusion CT unmask postictal stroke mimics? A case-control study of 133 patients. Neurology. 2018;91:1918–27.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.MR Unit, Radiology DepartmentVall d’Hebron University HospitalBarcelonaSpain
  2. 2.Epilepsy Unit, Neurology DepartmentVall d’Hebron University HospitalBarcelonaSpain

Section editors and affiliations

  • N. Bargalló
    • 1
  1. 1.Magnetic Resonance Image Core Facility. Institut de Investigació Biomèdica August Pi I Sunyer (IDIBAPS)Image Diagnosis Center (CDIC). Hospital Clínic de BarcelonaBarcelonaSpain

Personalised recommendations