AJNR: Abnormal tongue signal on emergency MRI for the diagnosis of seizures

Transient loss of consciousness (TLoC) is a spontaneous, transient, fully recovered loss of consciousness
.
It is estimated that TLoC occurs in up to 50% of people in their lifetime and accounts for 3% of emergency department (ED) visits

The two most common causes of TLoC, ES and PNES, have terminology that can be confusing
.
Therefore, ES and PNES are described in this paper

In September 2021, Paul M.
Bunch et al.
from the United States published their findings in AJNR, and they hypothesized that TSA was associated with the clinical diagnosis of ES
.
The aims of this study were as follows: 1) to determine the prevalence of TSA in ED patients undergoing brain magnetic resonance imaging to find the etiology of TLoC, and 2) to assess the association between TSA and the eventual diagnosis of seizures

Figure 1.
Axial T2-weighted fat-suppressed color overlay image, visual criteria for areas of abnormal tongue signal, including the tip of the tongue (shaded in blue), the lateral tongue (shaded in yellow), or both:

Figure 2.
Representative example of TSA images (arrows, AD) of 4 emergency room patients
.

In this retrospective study, which included 82 brain MRIs, 2 experts independently assessed tongue signal abnormalities on T2-weighted and T2-weighted FLAIR images

Abnormal tongue signal was found in 19/82 (23%) MRI examinations
.
The intra-rater reliability was 'substantial' (k=0.

The authors concluded that abnormal tongue signal was observed in 23% of patients in this study cohort, with a specificity of 97% and a positive predictive value of 95% for the diagnosis of seizures
.
Evaluation and reporting of abnormal tongue signals may help patients with transient loss of consciousness be diagnosed with a timely and accurate seizure

Literature source:

JA Erickson, MD Benayoun, CM Lack, et al.