MRI:
Small volume hippocampus on coronal volumeteric T1
Increased signal on coronal FLAIR
Small mamillary body
Small fornix
Temporal lobe atrophy
Ipsilateral white matter atrophy
Increased signal/ loss of volume of anterior thalamic nucleus
Increased signal/ loss of volume of amygdala
Loss of volume of sibiculum
Loss of grey-white in the anterior temporal lobe
Higher signal on ADC (but may have restricted diffusion following seizure)
Temporal horn dilatation - least sensitive sign
Ipsilateral cerebral hypertrophy
Contralateral cerebellar atrophy
Rememeber:
10% are bilateral, hence comparison with other side is not always useful
MRS:
Decreased NAA
Decreased NAA / Cho ratio
Decreased NAA / Cr ratio
Decreased MI
Increased lipid and lactate soon after as seizure
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