Abstract
Background Dot sign- punctate foci of diffusion restriction on MRI DWI (diffusion weighted imaging) has been established as a radiological finding in Transient Global Amnesia (TGA).1
This sign can also be seen in non TGA presentations, and we outline a status epilepticus presentation below.
Case A 66 year old scientist went to sleep at 8pm and woke up his wife at midnight with his generalised tonic clonic seizure like activity lasting minutes. His GCS (Glasgow coma scale) was 7 and he was intubated and ventilated in the regional Hospital Emergency department before being flown to a tertiary hospital Intensive care unit, for further review, and neurological investigations.
Patient had no known history of seizures and his past medical history included ischaemic heart disease, undergoing coronary bypass graft in 2020, Hypertension and Type 2 Diabetes Mellitus.
He spontaneously recovered and was extubated and back to baseline GCS 15 on the neurological inpatient ward.
His MRI Brain demonstrated classic "dot sign" in the left hippocampal region.
EEG demonstrated diffuse bilateral slowing.
Conclusion "Dot sign" is an interesting finding, not always related to TGA, and has been shown to be associated with status epilepticus.2
References
Park JH, Oh CG, Kim SH, Lee SH, Jang JW. Hippocampal lesions of diffusion weighted magnetic resonance image in patients with headache without symptoms of transient global amnesia. Dement Neurocogn Disord. 2017 Sep;16(3):87–90.
Meletti S, Monti G, Mirandola L, Vaudano AE, Giovannini G. Neuroimaging of status epilepticus. Epilepsia. 2018;59(S2):113–119.
