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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain

Decreased Subcortical T2 FLAIR Signal Associated with Seizures

P. Nicholson, S. Abdulla, L. Alshafai, D.M. Mandell and T. Krings
American Journal of Neuroradiology January 2020, 41 (1) 111-114; DOI: https://doi.org/10.3174/ajnr.A6328
P. Nicholson
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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S. Abdulla
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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L. Alshafai
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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D.M. Mandell
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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T. Krings
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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    Fig 1.

    Patient admitted to the intensive care unit with persistent seizures 1 day after evacuation of a left-sided subdural hematoma. A, T2 FLAIR, B, FSE T2, C, DWI, and D, GRE-weighted images. Note the decreased T2-weighted signal in the subcortical white matter of the left frontal and parietal lobes on A and B, as well as the lack of corresponding diffusion restriction on C. D, GRE-weighted image shows there is subtle corresponding decreased subcortical white matter signal change.

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    Fig 2.

    A, T2 FLAIR images from a 49-year-old male patient being followed for a left-frontal meningioma with asymptomatic low signal in the subcortical white matter adjacent to the meningioma. Nonspecific failure of suppression of CSF signal in the subjacent sulci was also noted. B, T2 FLAIR images showing low signal in the left occipital lobe in a 46-year-old patient who initially presented with visual seizures. C, T2 FLAIR images from a 48-year-old patient with a left convexity subdural hematoma and seizures. Subcortical low T2 signal is present in the compressed posterior frontal and parietal lobes.

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    Fig 3.

    A, T2 FLAIR image in the same patient as in Fig 2A shows complete resolution of the white matter changes 2 years after resection of the lesion. B, T2 FLAIR image from a 53-year-old female patient with a spontaneous right-sided acute subdural hematoma. T2 hypointense signal changes are present in the subjacent white matter. C, Follow-up 5 months later shows resolution of both the hematoma and the white matter changes.

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  • Summary of imaging and clinical findings in patients with abnormally decreased T2 signal

    Findings
    Demographics
     Patients29
     Sex (male)19 (65.5%)
     Age (yr)49 (range, 18–85)
    Clinical information
     Associated seizures22 (75.9%)
     Extrinsic compressive lesions14 (48.3%)
    Imaging findings
     Laterality
      Bilateral7 (24.1%)
      Unilateral22 (75.9%)
     Multiple lobes involved21 (72.4%)
     Frequency of involved lobes
      Frontal19 (65.5%)
      Parietal17 (58.6%)
      Temporal16 (55.2%)
      Occipital14 (48.3%)
    EEG findings
     Availability19 (65.5%)
     Laterality
      Unilateral12/12 Cases with MRI T2 changes unilateral
      Bilateral7/7 Cases with MRI T2 changes bilateral
    Follow-up imaging
     Availability9 (31%)
     Changes resolved6 (66.6%)
      Associated with compressive lesion4/6
     Nonresolved/gliosis3 (33.3%)
      Associated with  compressive lesion1/3
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American Journal of Neuroradiology: 41 (1)
American Journal of Neuroradiology
Vol. 41, Issue 1
1 Jan 2020
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Cite this article
P. Nicholson, S. Abdulla, L. Alshafai, D.M. Mandell, T. Krings
Decreased Subcortical T2 FLAIR Signal Associated with Seizures
American Journal of Neuroradiology Jan 2020, 41 (1) 111-114; DOI: 10.3174/ajnr.A6328

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Decreased Subcortical T2 FLAIR Signal Associated with Seizures
P. Nicholson, S. Abdulla, L. Alshafai, D.M. Mandell, T. Krings
American Journal of Neuroradiology Jan 2020, 41 (1) 111-114; DOI: 10.3174/ajnr.A6328
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