mAlbert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Primary care physician. nWalter Reed National Military Medical Center, Bethesda, Maryland. oUniversity of Illinois at Chicago College of Medicine, Chicago, Illinois, Neurosurgery expert. pColumbia University Medical Center, New York, New York. qSpecialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia. Reprint requests to: publications@acr.org Seizures and Epilepsy have an anticonvulsant effect and can be evaluated with different tracers including 18F-MPPF [11]. Changes in dopamine receptors have also been associated with various forms of epilepsy [12] and can be evaluated with 18F- fallypride. Alpha-[11C]methyl-L-tryptophan is a tryptophan analogue and has been shown to be a useful radiotracer in assessing seizures in patients with tuberous sclerosis, temporal lobe epilepsy (TLE), and cortical dysplasia [13]. Diffusion tensor imaging that utilizes data from directionally encoded diffusion-weighted imaging has also been utilized to assess disruption in white matter tracks following trauma; however, its use in this capacity remains investigational [14]. Discussion of Procedures by Variant Variant 1: New-onset seizure. Unrelated to trauma. Initial imaging. CT Head Noncontrast CT has a central role in the emergent situation of acute seizures as it can accurately and rapidly identify structural pathology, such as intracranial hemorrhage, stroke, vascular malformation, hydrocephalus, and tumors, which may require either supportive treatment or neurosurgical care [15,16]. CT is also sensitive in detection of calcified and bony lesions. It is less sensitive in detection of lesions in the orbitofrontal and medial temporal regions, and also in the detection of small cortical lesions [17]. Contrast-enhanced CT can be considered to better define tumors and evaluate for infection; however, MRI is a better option in this situation.
Seizures and Epilepsy. mAlbert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Primary care physician. nWalter Reed National Military Medical Center, Bethesda, Maryland. oUniversity of Illinois at Chicago College of Medicine, Chicago, Illinois, Neurosurgery expert. pColumbia University Medical Center, New York, New York. qSpecialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia. Reprint requests to: publications@acr.org Seizures and Epilepsy have an anticonvulsant effect and can be evaluated with different tracers including 18F-MPPF [11]. Changes in dopamine receptors have also been associated with various forms of epilepsy [12] and can be evaluated with 18F- fallypride. Alpha-[11C]methyl-L-tryptophan is a tryptophan analogue and has been shown to be a useful radiotracer in assessing seizures in patients with tuberous sclerosis, temporal lobe epilepsy (TLE), and cortical dysplasia [13]. Diffusion tensor imaging that utilizes data from directionally encoded diffusion-weighted imaging has also been utilized to assess disruption in white matter tracks following trauma; however, its use in this capacity remains investigational [14]. Discussion of Procedures by Variant Variant 1: New-onset seizure. Unrelated to trauma. Initial imaging. CT Head Noncontrast CT has a central role in the emergent situation of acute seizures as it can accurately and rapidly identify structural pathology, such as intracranial hemorrhage, stroke, vascular malformation, hydrocephalus, and tumors, which may require either supportive treatment or neurosurgical care [15,16]. CT is also sensitive in detection of calcified and bony lesions. It is less sensitive in detection of lesions in the orbitofrontal and medial temporal regions, and also in the detection of small cortical lesions [17]. Contrast-enhanced CT can be considered to better define tumors and evaluate for infection; however, MRI is a better option in this situation.