REFRACTORY STATUS EPILEPTICUS ASSOCIATED WITH PROGRESSIVE MAGNETIC-RESONANCE-IMAGING SIGNAL CHANGE AND HIPPOCAMPAL NEURONAL LOSS

A 3-year-old boy developed refractory generalized status epilepticus ( SE) of unknown etiology that persisted for 6 weeks despite aggressive antiepileptic drug (AED) treatment. The initial magnetic resonance ima ging (MRI) scan of brain was normal. Two subsequent MRI scans, perform ed using a fast spin echo technique, showed progressive increases in T 2 signal in both hippocampi. After the child's death, histopathology s howed extensive neuronal necrosis and gliosis in bilateral hippocampal subfields CA1, CA3, and CA4/dentate hilus. This case confirms that re fractory SE is associated with neuropathologic findings in humans simi lar to those observed in animal models of SE and that such changes can be predicted by serial MRI signal abnormalities.