6533b831fe1ef96bd1299a14

RESEARCH PRODUCT

Treatment of pemphigus vulgaris with mycophenolate mofetil

subject

description

different pattern of diffusion changes in a 51-year-old woman with chronic epilepsy and recurrent episodes of focal status epilepticus, for whom no aetiology could be established. Status consisted of clonic jerking of the right leg, which continued for 22 days and was followed by transient paresis. DWI during status showed decreased diffusion in the motor cortex of the right leg (relative decrease in ADC of 27%, see figure). Surprisingly, the diffusion was increased in the subcortical white matter (relative increase in ADC of 31%). On the T2-weighted image (not shown), both cortex and subcortical white matter of the corresponding region returned a high signal similar to previously reported cases. 4 After cessation of the status, during transient paresis, repeat DWI and T2-weighted imaging showed resolution of these abnormalities. Resolution of diffusion changes preceded functional recovery. The pattern of diffusion changes observed by us differed from the changes observed so far in brain ischaemia and experimental status, since the decrease in cortical diffusion was associated with increased diffusion in the subcortical white matter. A possible explanation for the pattern of diffusion changes is water shifts associated with protracted epileptic activity. During epileptic activity, the extracellular space shrinks due to a water flux into cells at the area of maximum neuronal activity (in the cortex), 5 which would