Rasmussen Syndrome: Multifocal Spread of Inflammation Suggested from MRI and PET Findings

• Published in: Epilepsia (Copenhagen) Vol. 44; no. 8; pp. 1118 - 1121
• Main Authors: Maeda, Yumi, Oguni, Hirokazu, Saitou, Yoshiaki, Mutoh, Ayako, Imai, Kaoru, Osawa, Makiko, Fukuyama, Yukio, Hori, Tomokatsu, Yamane, Fumitaka, Kubo, Osamu, Ishii, Kenji, Ishiwata, Kiichi
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK Blackwell Science Inc 01.08.2003; Blackwell
• Subjects: 11C]methionine PET; Autonomic Nervous System Diseases - diagnosis; Biological and medical sciences; Carbon Radioisotopes; Cerebral Cortex - pathology; Cerebral Cortex - physiopathology; Child; Disease Progression; Dominance, Cerebral - physiology; Encephalitis - diagnosis; Encephalitis - pathology; Encephalitis - physiopathology; Epilepsia Partialis Continua - diagnosis; Epilepsia Partialis Continua - pathology; Epilepsia Partialis Continua - physiopathology; Epilepsy; Epilepsy, Partial, Motor - diagnosis; Epilepsy, Partial, Motor - pathology; Epilepsy, Partial, Motor - physiopathology; Epilepsy, Temporal Lobe - diagnosis; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - physiopathology; Female; FLAIR image; Fluorodeoxyglucose F18; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Image Enhancement; Magnetic Resonance Imaging; Medical sciences; Methionine; Multifocal spread; Nervous system (semeiology, syndromes); Neurology; Occipital Lobe - pathology; Occipital Lobe - physiopathology; Rasmussen syndrome; Temporal Lobe - pathology; Temporal Lobe - physiopathology; Tomography, Emission-Computed; Radionuclide study; Human; Nervous system diseases; Pathophysiology; Epilepsy; Emission; Inflammation; Nuclear magnetic resonance imaging; Cerebral disorder; Case study; Rasmussen syndrome; Central nervous system disease; Medical imagery; Rasmussen syndrome-FLAIR image-[11C]methionine PET-Multifocal spread; Child; Positron; Emission tomography
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1046/j.1528-1157.2003.67602.x

Background: A 6‐year‐old girl with Rasmussen syndrome (RS) showed multiple small high‐signal‐intensity areas independently in the right hemisphere by fluid‐attenuated inversion recovery (FLAIR) imaging on magnetic resonance imaging (MRI) 1 year after the onset of epilepsy. Methods: MRI performed 4 months later demonstrated a further increase in the number of these foci and enlargement in the size of the previous FLAIR lesions. Results: An [18F]‐fluorodeoxyglucose–positron emission tomography (FDG‐PET) study showed a strong, spotty uptake in the right temporooccipital regions, corresponding to the sites of continuous EEG seizure discharges. In contrast, [11C]methionine PET demonstrated multifocal uptake regions, which corresponded anatomically to the FLAIR lesions, suggesting sites of underlying chronic inflammation. Conclusions: These neuroimaging findings suggested that the inflammatory process in RS spreads either multifocally at the same time, as seen in this case, or from one discrete area to the adjacent region, as reported previously.