Refractory status epilepticus associated with progressive magnetic resonance imaging signal change and hippocampal neuronal loss

A 3-year-old boy developed refractory generalized status epilepticus (SE) of unknown etiology that persisted for 6 weeks despite aggressive antiepileptic drug (AED) treatment. The initial magnetic resonance imaging (MRI) scan of brain was normal. Two subsequent MRI scans, performed using a fast spin echo technique, showed progressive increases in T2 signal in both hippocampi. After the child's death, histopathology showed extensive neuronal necrosis and gliosis in bilateral hippocampal subfields CA1, CA3, and CA4/dentate hilus. This case confirms that refractory SE is associated with neuropathologic findings in humans similar to those observed in animal models of SE and that such changes can be predicted by serial MRI signal abnormalities.