Al-Hamadani et al (2020): MRI in epilepticus January 2020 Vol. 23 (I) ©Annals of Tropical Medicine & Public Health S421 The role of brain MRI in status epilepticus Yahya Mohammed Yaseen 1 , Dr. Noor Kathem Nee'ma Al-Waely 2 , Hasan Azeez Al-Hamadani *3 1 M. B. Ch. B. ministry of health/Iraq. 2 M. B. Ch. B., F.I. B. M. S (radiologist)/Lecturer at Al-Nahrain University/Medical College/Iraq 3 F. I. C. M. S (Neurologist)/Section of Neuromedicine, Department of Medicine, Al-Nahrain University/Medical College/Iraq *Corresponding author: Professor Dr. Hasan Azeez Al-Hamadani (qaisajam1981@gmail.com) Abstract: Magnetic Resonance Imaging (MRI) is increasingly being used as an investigation tool in status epilepticus (SE). It measures edema and cytotoxic edema that includes both cortical and/or subcortical constructions. The objective of our study is to identify the brain MRI changes that occur in patients with status epilepticus. A cross can aid in understanding ictal/postictal pathophysiology. Peri-ictal abnormalities may apparent as vasogenic -sectional analytic study conducted on patients with status epilepticus admitted to the emergency room or neurological ward at Al –Imamain AL-Kadhymain Medical City and AL-Yarmook Teaching Hospital for the period between January 2018 and January 2019. Brain MRI exam was performed for eligible patients using 3 Tesla MRI unit utilizing standard imaging protocol consisting of the following sequences: axial T2, coronal FLAIR, axial and/or sagittal T1, DWI and ADC maps with additional sequences tailored by the available clinical data and the imaging findings. Patients with positive MRI findings attributable to status were followed up by an MRI exam after 3 months. 28 patients were included in this study. The mean age of the patients was 40.6±18.4 years and the age range 18-80 years. Female to male ratio was 2.1:1. The frequency of MRI changes in SE patients was 3 out of 28 (10.7%). History of epilepsy was present among 28.6% of patients with SE. The primary etiology of status epilepticus for patients with MRI changes were a remote ischemic stroke for one patient and idiopathic etiology for the other two patients. Follow up MRI showed that two patients (66.7%) had reversible MRI changes, while one patient (33.35%) had mixed reversible and irreversible changes. A significant negative association was observed between the time interval from SE onset to MRI and the development of SE-related brain MRI changes (p=0.02). Our results show that 10.7 % of patients with status epilepticus had positive brain MRI changes attributable to status. The earlier an MR exam is performed for these patients, the more likely that MRI changes will be observed. Keywords: status epilepticus, MRI changes, vasogenic, peri-ictal How to cite this article: Yaseen YM, Al-Waely NKN, Hamadani HA (2020): the role of brain MRI in status http://doi.org/10.36295/ASRO.2020.23135 . DOI: n Trop Med & Pub Health; 23:S421 , An us epileptic Abbreviations: Apparent diffusion coefficient ( ADC ) , Diffusion Weighted Imaging ( DWI ) ,Echo Time ( TE) , Emergency Room (ER),Inversion Recovery (IR),Magnetic Resonance Imaging (MRI), Repetition Time (TR), Status Epilepticus (SE) , T1 Weighted Image (T1WI) , T2 Weighted Image ( T2WI). Introduction: Status epilepticus is a nervous emergent disease that needs emergent treatment within minutes to prevent any neurological injury. It happens as a significant failing in seizure end mechanisms or the progress of actions leading to lengthy seizure action 1 . The reported annual incidence rate is approximately 12.6 per 100,000 people per year 2 with the incidence peaking at ages older than 50 years and younger than 10 3 . The exact pathophysiology of peri-ictal changes in SE is not fully understood yet. Both cytotoxic and vasogenic types of edema have been implicated. Trial models and numerous patients with partial SE cases point to cytotoxic edema as the predominant finding 4, 5 . A reduction in extracellular fluid causes the restricted diffusion on MRI in these cases 6 . The fact that these lesions are usually reversible denotes that cell death is not an inevitable consequence 7 . Though the findings are usually reversible, most of the irreversible brain damage has been linked to the presence of cytotoxic edema 8, 9 . On the other hand, there are accounts that approval the occurrence of vasogenic edema in status epilepticus-related MRI changes 10 . High metabolic demand and an increase in perfusion caused by seizure activity may explain the vasogenic edema 11 . The changes that occur as a result of vasogenic edema are mostly reversible 12 . Magnetic resonance imaging (MRI) is a vital examination instrument in SE as it can not only visualize the causative underlying pathology but also gives an insight into the pathophysiology of the peri-ictal changes within the brain 13 . Diffusion Weighted Imaging (DWI) along with ADC maps is a sensitive