| Abstract [eng] |
Seizure attacks occur in approximately 8-10 percent of the population throughout their lifetime. While most seizures resolve spontaneously, some patients develop an epileptic condition or experience residual and long-term impairments in speech, motor skills, and cognition. Prolonged seizures involve complex endogenous processes in the brain, leading to cytotoxic edema, later to vasogenic edema and secondary brain damage. With the implementation of brain imaging diagnostic methods to determine the etiology of seizures, it has been observed that some patients have brain damage caused directly by the seizures themselves rather than underlying conditions that trigger the seizures. Magnetic resonance imaging (MRI) commonly reveals localized cortical edema (with high intensity in the T2 FLAIR sequence), positive diffusion restriction, and focal parenchymal and/or leptomeningeal contrast enhancement. Distinct changes are also observed in the ipsilateral intermediate brain structures and contralateral cerebellum, away from the initial seizure activity zone. These changes are reversible in nature, and their consequences are temporary but can vary in duration, leading to challenges in differential diagnosis. Seizure-related changes often need to be differentiated from acute cerebrovascular disorders and inflammatory changes. The aim of this study is to present the clinical cases of two patients treated at the Republican Vilnius University Hospital, where a first-time and prolonged seizure caused lasting structural brain changes in imaging studies and long-term neurological consequences. The study includes a literature analysis of the pathophysiological mechanisms occurring during prolonged seizures that can lead to long-term brain damage, pathological findings on magnetic resonance imaging during and after seizures (periictal period), predisposing factors for prolonged seizures, and differential diagnosis. |
