Early MRI changes in status epilepticus: Associations with seizure characteristics, EEG findings, and prognosis in patients without large lesions

To investigate the role, frequency, and pattern of signal changes in cranial MRI associated with status epilepticus (SE) and their correlation with EEG and clinical findings in patients with large lesions, such as tumors, strokes, or major space-occupying anomalies. This retrospective cohort study included 44 patients diagnosed with SE between January 2013 and June 2019. Data on demographic and clinical characteristics, seizure semiology, SE features (type and prognosis), and EEG and MRI findings were collected from hospital records. The relationships between periictal MRI abnormalities, MRI lateralization, clinical semiology, EEG findings, SE prognosis, and outcome at discharge were analyzed. The median age of participants was 61.5 years, with 65.91% being female. Bilateral MRI signals were significantly more common in patients with generalized convulsive SE. Patients with SWI signal changes had a significantly lower median age and a higher percentage of previous epilepsy history. Increased signal intensity on DWI and T2-FLAIR sequences was observed in 86.4% and 22.7% of patients, respectively. Among those with increased DWI signals, the neocortex was a common localization (45.45%). The group with T2-FLAIR signal increases had a significantly lower median age, a higher percentage of generalized convulsive SE, and a lower percentage of non-convulsive SE. Poor prognosis was observed in 40.91% of patients, with generalized EEG findings significantly more frequent in this group. Periictal MRI findings in SE patients demonstrated significant associations with clinical presentation but showed no correlation with EEG or prognosis. Further research is needed to explore the link between MRI findings and SE prognosis in the acute phase.