Association of different uncus lesions on magnetic resonance imaging with epilepsy

Parahipokampal girusun çengel şeklindeki anteromedial kısmı olan unkus, limbik sistemin bir parçasıdır. Amigdala ile birlikte nükleus içeren tek girus parçası olup olfaktör halüsinasyonların eşlik ettiği epilepsiler ile ilişkilidir. Bu çalışmada manyetik rezonans görüntüleme (MRG) ile saptanan farklı unkus lezyonlarının klinik olarak epilepsi ile ilişkileri araştırılmıştır. Yöntem: Mart 2008- Mayıs 2014 tarihleri arasında kranial MRG'de tek taraflı ya da iki taraflı unkus lezyonu saptanan 33 hastanın lezyonları ve dosyaları retrospektif olarak incelendi. Klinik olarak epilepsi/nöbet varlığı ve MR bulguları ile ilişkisi değerlendirildi. Bulgular: Çalışmaya alınan 33 hastanın 12'sinde (%36) iki taraflı, 21'inde (%64) tek taraflı unkal lezyon vardı. Herpes ensefaliti (n=5), otoimmün limbik ensefalit (n=2), mezial temporal skleroz (n=3), metastaz (n=1) ve Rasmussen ensefaliti (n=1) bilateral tutulum yaparken, glial tümör (n=4), metastaz (n=4), mezial temporal skleroz (n=4), kavernöz anjiom (n=2), disembrioplastik nöroepitelyal tümör (n=5), herpes ensefaliti (n=1) otoimmün limbik ensefalit (n=1) ise tek taraflı unkal lezyonlara neden olmuştu. Hastaların 2/3'ünde epilepsi/nöbet mevcuttu, ancak unkus metastazı olan 5 hastada epilepsi/nöbet görülmedi. Sonuç: MRG ile unkus tutulumu yapan pek çok değişik patoloji saptanmakta olup unkus lezyonlarının büyük bölümü epilepsi ile ilişkilidir

Manyetik rezonans görüntülemede saptanan farklı unkus lezyonlarının epilepsi ile ilişkisi

Uncus is the hook-like most anteromedial portion of the parahippocampal gyrus and is a part of the limbic system. It is the only gyrus, together with the amygdala, that contains nuclei and is associated with seizures accompanied by olfactory hallucinations. The aim of this study is to examine the relationship between different uncus lesions detected by magnetic resonance imaging (MRI) and epilepsy/seizures. Method: 33 patients with unilateral or bilateral uncus lesions on MRI obtained between March 2008 through May 2014 were enrolled in the study. MR images and clinical charts of patients were retrospectively investigated for MRI findings and presence of epilepsy/seizures. Results: Bilateral uncus involvement was observed in herpes encephalitis (n=5), autoimmune limbic encephalitis (n=2), mesial temporal sclerosis (n=3), metastasis (n=1) and Rasmussen encephalitis (n=1), whereas unilateral involvement of the uncus was seen in glial tumors (n=4), metastases (n=4), mesial temporal sclerosis (n=4), cavernous angioma (n=2), dysembryoplastic neuroepithelial tumor (DNET, n=5), herpes encephalitis (n=1), and autoimmune limbic encephalitis (n=1). Epilepsy/seizures were present in two-thirds of patients. However, none of the 5 patients with a metastatic uncus lesion showed epilepsy/seizures. Conclusions: Many uncus pathologies can be detected by MRI and most of them are associated with epilepsy

PDF

___

Leuner B, Gould E. Structural Plasticity Function. Annu Rev Psychol 2010; 61: 111-40. Hippocampal
Kieman JA. Anatomy of the temporal lobe. Epilepsy Res Treat 2012 (2012); Article ID: 176157 doi: 10.1155/2012/176157
Murty V, Calabro F, Luna B. The role of experience in adolescent cognitive development: Integration of mesolimbic Biobehav Rev 2016 pii: S0149- 7634(16)30160-2 10.1016/j.neubiorev.2016.07.034
Papinutto N, Galantucci S, Mandelli ML, Gesierich B, Jovicich J, Caverzasi E, Henry RG, Seeley WW, Miller BL, Shapiro KA, Gorno- Tempini ML. Structural connectivity of the human anterior temporal lobe: A diffusion magnetic resonance imaging study. Hum Brain Mapp 2016; 37: 22-10-22.
Mackay FH. Uncinate fits. Can Med Assoc J 1924; 14: 233-235
Mizobuchi M, Ito N, Tanaka C, Sako K, Sumi Y, Sasaki T. Unidirectional olfactory hallucination associated with intracranial 1999; 40: 516-9. unruptured Epilepsia aneurysm.
Lin HS, Tsai CC, Chang CK, Chen SJ. Giant intracranial mesenchymal chondrosarcoma herniation. Formosan Journal of Surgery 2012; 45: 93e96. uncal
Usui N. Current topics in epilepsy surgery. Neurol Med Chir 2016; 56: 228-35.
Park HR, Chung HT, Lee SK, Kim DG, stereotactic radiosurgery for medial temporal lobe epilepsy: A case report. Exp Neurobiol 2016; 25: 93-101. knife
JettéN, Sander JW, Keezer MR. Surgical treatment for epilepsy: the potential gap between evidence and practice. Lancet Neurol 2016; 15: 982-94.
Sindou M, Guenot M. Surgical anatomy of the temporal lobe for epilepsy surgery. Adv Tech Stabd Neurosurg 2003; 28: 315-43.
Zentner J, Hufnagel A, Wolf HK, Ostertun B, Behrens E, Campos MG, Solymosi L, Elger CE, Wiestler OD, Schramm J. Surgical treatment of temporal lobe epilepsy: clinical, radiological, and histopathological findings in 178 patients. J Neurol Neurosurg Psychiatry 1995; 58: 666- 73.
Cross DJ, Anzai Y, Petrie EC, Martin N, Richards TL, Maravilla KR, Peskind ER, Minoshima S. Loss of olfactory tract integrity affects cortical metabolism in the brain and olfactory regions in aging and mild cognitive impairment. J Nucl Med 2013; 54: 1278-84.
Garcia-Casares N, Jorge RE, Garcia- Arnés JA, Acion L, Berthier ML, Gonzales-Alegre P, Nabrozidis A, Gutiérrez A, Ariza MJ, Rioja J, Gonzaléz-Santos P. Cognitive with dysenmbrioplastic
Capizzano AA, Kirby P, Moritani T. Limbic Tumors of the Temporal Lobe: Correlation. Clin Neuroradiol. 2015; 25: 127-35 .
Maschio M. Brain Tumor-Related Epilepsy. 2012; 10: 124-33.