Here in this lecture we will discuss two main points: 1. Analyzing the MRI images and their relationship to Encephalitis. 2. Explaining that how neurosurgical operation can assist in treatment of intractable epilepsy. Pathology of Encephalitis: In acute encephalitis, inflammation and edema occur in infected areas throughout the cerebral hemispheres, brain stem, cerebellum, and, occasionally, spinal cord. Petechial hemorrhages may be present in severe infections. Direct viral invasion of the brain usually damages neurons, sometimes producing microscopically visible inclusion bodies. MRI analysis: The right occipital leaf-shaped slightly longer T2 signal shadow, consider infarction. Right occipital lobe-shaped FS like high signal, consider infarction or brain contusion. Intractable epilepsy: Intractable epilepsy is when seizures can't be controlled by medicines. Intractable epilepsy is diagnosed when someone has had years of uncontrolled seizures. Many people whose seizures do not respond to medication will respond to surgical treatment, relieving seizures completely or almost completely in one-half to two-thirds of patients who qualify for surgery. Epilepsy surgery is usually performed during general anesthesia, and you'll be unconscious during the procedure. In rare circumstances, your surgeon may awaken you during part of the operation to help the team determine which parts of your brain control language and movement. In such cases, you would receive medication to control pain. The surgeon creates a relatively small window in the skull, depending on the type of surgeryAfter surgery the window of bone is replaced and fastened to the remaining skull for healing. Presented by: Mohammadsaleh Moallem

1. Encephalitis
Presented by: Mohammadsaleh Moallem

2. Encephalitis
Presented by: Mohammadsaleh Moallem
Questions:
1. Please Analyze the MRI images and their relationship to the disease? (normal vs abnormal)
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

3. Question 1:
1. Please Analyze the MRI images and their relationship to
the disease? (normal vs abnormal)

4. Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

5. Encephalitis:
The inflammation causes the brain to swell, which can
lead to headache, stiff neck, sensitivity to light, mental
confusion and seizures.
Encephalitis is an inflammation of the brain tissue.
The Viral form of encephalitis usually affects the temporal
lobe, the part of the brain that controls memory and
speech. It can also affect the frontal lobe, the part that
controls emotions and behavior
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

6. Pathology of Encephalitis:
In acute encephalitis, inflammation and edema occur in
infected areas throughout the cerebral hemispheres,
brain stem, cerebellum, and, occasionally, spinal cord.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

7. Pathology of Encephalitis:
Petechial hemorrhages may be present in severe infections. Direct
viral invasion of the brain usually damages neurons, sometimes
producing microscopically visible inclusion bodies.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

8. Encephalitis MRI analysis:
MRI shows hypersensitivity
involving the cortical and the
subcortical regions of bilateral
temporal, frontal lobes, and
insula on T2-weighted images
(WI).
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

9. Encephalitis MRI analysis:
T2WI bilateral occipital lobes
showed a slightly longer T2
signal, and water pressure
showed a long T2 signal,
which is considered to be
cerebral infarction or brain
contusion.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

10. Encephalitis MRI analysis:
The right occipital lobe water
suppression sequence shows
a patchy high signal. Neither
T1WI nor T2WI is displayed
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

11. Encephalitis MRI analysis:
The right occipital leaf-shaped
slightly longer T2 signal
shadow, consider infarction.
Right occipital lobe-shaped FS
like high signal, consider
infarction or brain contusion
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

12. Encephalitis MRI analysis:
The right occipital leaf-shaped
slightly longer T2 signal
shadow, consider infarction
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

13. Other MRI images:
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

14. Other MRI images:
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

15. Other MRI images:
Fluid attenuated inversion recovery (FLAIR) changes are noted in the mesial
frontal and temporal regions and right insula (A and B).
MRI showed increased FLAIR changes with extensive involvement of bilateral
frontal and bilateral temporal lobes, predominantly right-sided along with right-
sided occipital involvement.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

16. Other MRI images:
(A) MRI scan with fluid-attenuated inversion recovery (FLAIR) showing mildly high
signal intensities in the bilateral thalami (arrows) (B) Brain MRI with FLAIR
showing markedly high signal intensities in the bilateral thalami (arrows), caudate
nuclei and internal capsules.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

17. Other MRI images:
FLAIR shows extensive abnormal high signal in the classic distribution seen in HSV
encephalitis (arrows) – the medial aspects of the temporal lobes, and the infero-
medial aspects of the frontal lobes.
The coronal post-gadolinium T1-weighted image on the right shows abnormal
meningeal thickening and enhancement, arrowheads.
Question 1:
1. PleaseAnalyze the MRI images and their relationship to the disease? (normal vs abnormal)

18. Encephalitis
Presented by: Mohammadsaleh Moallem
Questions:
1. Please Analyze the MRI images and their relationship to the disease? (normal vs abnormal)
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

19. Question 2:
2. How neurosurgical operation can assist in treatment
of intractable epilepsy?

20. Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?
Intractable epilepsy:
Intractable epilepsy is when seizures can't be controlled by medicines.
Intractable epilepsy is diagnosed when someone has had years of
uncontrolled seizures.

21. Intractable epilepsy:
Many people whose seizures do not respond to medication will
respond to surgical treatment, relieving seizures completely or almost
completely in one-half to two-thirds of patients who qualify for
surgery.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

22. Intractable epilepsy:
Epilepsy surgery can be an effective and safe treatment for patients
with drug-resistant epilepsy. Although open resection still remains the
standard for epilepsy surgery, early results suggest that minimally
invasive surgical techniques may be an exciting and effective
alternative treatment to open surgery.
The potential for faster recovery time and reduced morbidity is
certainly an attractive treatment option. Further larger prospective
studies are needed to validate the safety, long-term efficacy, and cost
effectiveness of the emerging procedures in epilepsy surgery.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

23. Intractable epilepsy:
Epilepsy surgery is a procedure that removes an area of the brain
where seizures occur.
Epilepsy surgery is most effective when seizures always occur in a
single location in the brain. Epilepsy surgery is not the first line of
treatment but is considered when at least two anti-seizure
medications have failed to control seizures.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

24. During Surgery:
The heart rate, blood pressure and
oxygen levels will be monitored
throughout the surgery. An EEG
monitor also may be recording the
brain waves during the operation to
better localize the part of the brain
where the seizures start.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

25. During Surgery:
Epilepsy surgery is usually performed
during general anesthesia, and you'll be
unconscious during the procedure.
In rare circumstances, your surgeon may
awaken you during part of the operation
to help the team determine which parts
of your brain control language and
movement. In such cases, you would
receive medication to control pain.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

26. During Surgery:
The surgeon creates a relatively
small window in the skull,
depending on the type of surgery.
After surgery the window of bone
is replaced and fastened to the
remaining skull for healing.
Question 2:
2. How neurosurgical operation can assist in treatment of intractable epilepsy?

27. Thank you for your attention
Presented by: Mohammadsaleh Moallem
默汉 201816230152