eMedicine Specialties > Radiology > Brain/Spine

Mesial Temporal Sclerosis: Multimedia

Author: Scott Trepeta, MD, Director of Neuroradiology, Department of Radiology, Jamaica Hospital
Coauthor(s): Stephen Chan, MD, MBA, MPH, Consulting Staff, New York State Psychiatric Institute; Angela Lignelli-Dipple, MD, Assistant Professor of Radiology, Columbia University; Assistant Attending Physician, Department of Radiology, Division of Neuroradiology, Columbia Presbyterian Medical Center
Contributor Information and Disclosures

Updated: Aug 12, 2009

Overview
Imaging
Multimedia

Multimedia

(Enlarge Image)

Media file 1: Diagram of the hippocampal anatomy and adjacent structures in the mesial temporal lobe. The cornu ammonis, a part of the hippocampus, can be divided into four fields: CA1, CA2, CA3, and CA4.

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Diagram of the hippocampal anatomy and adjacent structures in the mesial temporal lobe. The cornu ammonis, a part of the hippocampus, can be divided into four fields: CA1, CA2, CA3, and CA4.

(Enlarge Image)

Media file 2: Anatomic diagram depicts the relationship of the hippocampus to other structures in the limbic system. Note that the cingulate gyrus is continuous with the parahippocampal gyrus.

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Anatomic diagram depicts the relationship of the hippocampus to other structures in the limbic system. Note that the cingulate gyrus is continuous with the parahippocampal gyrus.

(Enlarge Image)

Media file 3: Proper magnetic resonance imaging (MRI) plane for evaluation of the hippocampus is perpendicular to its long axis.

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Proper magnetic resonance imaging (MRI) plane for evaluation of the hippocampus is perpendicular to its long axis.

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Media file 4: Midline magnetic resonance image with proper section orientation.

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Midline magnetic resonance image with proper section orientation.

(Enlarge Image)

Media file 5: Normal findings on fluid-attenuated inversion recovery (FLAIR) magnetic resonance images obtained through the hippocampi. Note the normal, slightly increased signal intensity in the hippocampi.

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Normal findings on fluid-attenuated inversion recovery (FLAIR) magnetic resonance images obtained through the hippocampi. Note the normal, slightly increased signal intensity in the hippocampi.

(Enlarge Image)

Media file 6: Normal findings on T2-weighted magnetic resonance images obtained through the hippocampi.

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Normal findings on T2-weighted magnetic resonance images obtained through the hippocampi.

(Enlarge Image)

Media file 7: A 59-year-old patient with a history of temporal lobe epilepsy. The right hippocampus has increased signal intensity and volume loss.

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A 59-year-old patient with a history of temporal lobe epilepsy. The right hippocampus has increased signal intensity and volume loss.

(Enlarge Image)

Media file 8: Coronal T2-weighted magnetic resonance image in a 59-year-old patient (same patient as in Image 7) shows increased signal intensity and volume loss.

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Coronal T2-weighted magnetic resonance image in a 59-year-old patient (same patient as in Image 7) shows increased signal intensity and volume loss.

(Enlarge Image)

Media file 9: Axial magnetic resonance image in a 59-year-old patient (same patient as in Images 7-8). The right hippocampus has increased signal intensity; however, the signal intensity is less obvious in the axial plane than it is in the oblique coronal plane.

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Axial magnetic resonance image in a 59-year-old patient (same patient as in Images 7-8). The right hippocampus has increased signal intensity; however, the signal intensity is less obvious in the axial plane than it is in the oblique coronal plane.

$A 22-year-old patient with refractory temporal lo...$

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Media file 10: A 22-year-old patient with refractory temporal lobe epilepsy. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images of the left hippocampus show increased signal intensity and volume loss.

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$A 22-year-old patient with refractory temporal lo...$

A 22-year-old patient with refractory temporal lobe epilepsy. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images of the left hippocampus show increased signal intensity and volume loss.

(Enlarge Image)

Media file 11: T2-weighted magnetic resonance images reveal the increased signal and volume loss of the left hippocampus (same patient as in Image 10).

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T2-weighted magnetic resonance images reveal the increased signal and volume loss of the left hippocampus (same patient as in Image 10).

(Enlarge Image)

Media file 12: Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images in a 40-year-old patient with complex partial seizures. The right hippocampus is atrophic and has increased signal intensity that is compatible with mesial temporal sclerosis. Other associated findings of mesial temporal sclerosis are present and are better demonstrated on coronal T2-weighted magnetic resonance images than they are on these images.

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Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images in a 40-year-old patient with complex partial seizures. The right hippocampus is atrophic and has increased signal intensity that is compatible with mesial temporal sclerosis. Other associated findings of mesial temporal sclerosis are present and are better demonstrated on coronal T2-weighted magnetic resonance images than they are on these images.

(Enlarge Image)

Media file 13: Coronal T2-weighted magnetic resonance images demonstrate mesial temporal sclerosis on the right, as well as associated findings of a small right mammillary body and a small right fornix.

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Coronal T2-weighted magnetic resonance images demonstrate mesial temporal sclerosis on the right, as well as associated findings of a small right mammillary body and a small right fornix.

More on Mesial Temporal Sclerosis

Overview: Mesial Temporal Sclerosis

Imaging: Mesial Temporal Sclerosis

Multimedia: Mesial Temporal Sclerosis

References

Engel J Jr. Mesial temporal lobe epilepsy: what have we learned?. Neuroscientist. Aug 2001;7(4):340-52. [Medline].
Chernov MF, Ochiai T, Ono Y, Muragaki Y, Yamane F, Taira T, et al. Role of proton magnetic resonance spectroscopy in preoperative evaluation of patients with mesial temporal lobe epilepsy. J Neurol Sci. Jul 30 2009;[Medline].
Zijlmans M, de Kort GA, Witkamp TD, Huiskamp GM, Seppenwoolde JH, van Huffelen AC, et al. 3T versus 1.5T phased-array MRI in the presurgical work-up of patients with partial epilepsy of uncertain focus. J Magn Reson Imaging. Aug 2009;30(2):256-62. [Medline].
Provenzale JM, Barboriak DP, VanLandingham K, MacFall J, Delong D, Lewis DV. Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis. AJR Am J Roentgenol. Apr 2008;190(4):976-83. [Medline].
Focke NK, Yogarajah M, Bonelli SB, Bartlett PA, Symms MR, Duncan JS. Voxel-based diffusion tensor imaging in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Neuroimage. Apr 1 2008;40(2):728-37. [Medline].
National Institutes of Health Consensus Conference. Surgery for epilepsy. JAMA. Aug 8 1990;264(6):729-33. [Medline].
Xu S, Pang Q, Liu Y, et al. Neuronal apoptosis in the resected sclerotic hippocampus in patients with mesial temporal lobe epilepsy. J Clin Neurosci. Sep 2007;14(9):835-40. [Medline].
Graham DI, Lantos PL, eds. Greenfield's Neuropathology. 7^th ed. London, England: Arnold; 1997:950.
Lewis DV. Febrile convulsions and mesial temporal sclerosis. Curr Opin Neurol. Apr 1999;12(2):197-201. [Medline].
Engel J Jr, Pedley TA. Epilepsy: A Comprehensive Textbook. Philadelphia, Pa: Lippincott-Raven; 1998:517-24, 557-66.
Bronen RA, Fulbright RK, Spencer DD, et al. Refractory epilepsy: comparison of MR imaging, CT, and histopathologic findings in 117 patients. Radiology. Oct 1996;201(1):97-105. [Medline]. [Full Text].
Chan S, Erickson JK, Yoon SS. Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. Radiographics. Sep-Oct 1997;17(5):1095-110. [Medline]. [Full Text].
Lin K, Carrete H, Lin J, et al. Facial paresis in patients with mesial temporal sclerosis: clinical and quantitative MRI-based evidence of widespread disease. Epilepsia. Aug 2007;48(8):1491-9. [Medline].
Jack CR Jr, Rydberg CH, Krecke KN, et al. Mesial temporal sclerosis: diagnosis with fluid-attenuated inversion-recovery versus spin-echo MR imaging. Radiology. May 1996;199(2):367-73. [Medline]. [Full Text].
Capizzano AA, Vermathen P, Laxer KD, et al. Temporal lobe epilepsy: qualitative reading of 1H MR spectroscopic images for presurgical evaluation. Radiology. Jan 2001;218(1):144-51. [Medline]. [Full Text].
McBride MC, Bronstein KS, Bennett B, et al. Failure of standard magnetic resonance imaging in patients with refractory temporal lobe epilepsy. Arch Neurol. Mar 1998;55(3):346-8. [Medline]. [Full Text].
Jackson GD, Berkovic SF, Duncan JS, et al. Optimizing the diagnosis of hippocampal sclerosis using MR imaging. AJNR Am J Neuroradiol. May-Jun 1993;14(3):753-62. [Medline].
Berkovic SF, McIntosh AM, Kalnins RM, et al. Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology. Jul 1995;45(7):1358-63. [Medline].

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Keywords

mesial temporal sclerosis, MTS, hippocampal sclerosis, Ammon horn sclerosis, Ammon's horn sclerosis, complex partial seizures, temporal lobe epilepsy

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Contributor Information and Disclosures

Author

Scott Trepeta, MD, Director of Neuroradiology, Department of Radiology, Jamaica Hospital
Scott Trepeta, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, and American Society of Neuroradiology
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen Chan, MD, MBA, MPH, Consulting Staff, New York State Psychiatric Institute
Stephen Chan, MD, MBA, MPH is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

Angela Lignelli-Dipple, MD, Assistant Professor of Radiology, Columbia University; Assistant Attending Physician, Department of Radiology, Division of Neuroradiology, Columbia Presbyterian Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Mahesh R Patel, MD, Chief, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Mahesh R Patel, MD is a member of the following medical societies: American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

L Gill Naul, MD, Professor and Head, Department of Radiology, Texas A&M University College of Medicine; Chair, Department of Radiology, Chief, Section of Magnetic Resonance Imaging, Scott and White Memorial Hospital and Clinic
L Gill Naul, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Brain/Spine

Mesial Temporal Sclerosis: Multimedia

Multimedia

Diagram of the hippocampal anatomy and adjacent structures in the mesial temporal lobe. The cornu ammonis, a part of the hippocampus, can be divided into four fields: CA1, CA2, CA3, and CA4.

Anatomic diagram depicts the relationship of the hippocampus to other structures in the limbic system. Note that the cingulate gyrus is continuous with the parahippocampal gyrus.

Proper magnetic resonance imaging (MRI) plane for evaluation of the hippocampus is perpendicular to its long axis.

Midline magnetic resonance image with proper section orientation.

Normal findings on fluid-attenuated inversion recovery (FLAIR) magnetic resonance images obtained through the hippocampi. Note the normal, slightly increased signal intensity in the hippocampi.

Normal findings on T2-weighted magnetic resonance images obtained through the hippocampi.

A 59-year-old patient with a history of temporal lobe epilepsy. The right hippocampus has increased signal intensity and volume loss.

Coronal T2-weighted magnetic resonance image in a 59-year-old patient (same patient as in Image 7) shows increased signal intensity and volume loss.

Axial magnetic resonance image in a 59-year-old patient (same patient as in Images 7-8). The right hippocampus has increased signal intensity; however, the signal intensity is less obvious in the axial plane than it is in the oblique coronal plane.

A 22-year-old patient with refractory temporal lobe epilepsy. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance images of the left hippocampus show increased signal intensity and volume loss.

T2-weighted magnetic resonance images reveal the increased signal and volume loss of the left hippocampus (same patient as in Image 10).

Coronal T2-weighted magnetic resonance images demonstrate mesial temporal sclerosis on the right, as well as associated findings of a small right mammillary body and a small right fornix.

More on Mesial Temporal Sclerosis

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

CME Editor

Chief Editor