Philipp Eisele, Kristina Szabo and Achim Gass
A 42-year old woman with a 14 year history of secondary progressive multiple sclerosis developed new onset aphasia and disorientation. Magnetic Resonance Imaging (MRI) showed sequelae of ictal activity on diffusion- and perfusion-weighted MRI (hippocampal hyperintensity with a reduced apparent diffusion coefficient and spatially matching hyperperfusion). The epileptic origin was confirmed by c (EEG); under antiepileptic treatment aphasia improved over 3 days and the previous clinical disability level was reached, while the EEG normalised gradually. Isolated signal change restricted to the hippocampal area may provide a diagnostic clue to the underlying pathophysiology of confusional syndromes and help to identify non-convulsive status epilepticus.