Can Assessment of the Tongue on Brain MRI Aid Differentiation of Seizure from Alternative Causes of Transient Loss of Consciousness?

American Journal of Neuroradiology

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FIG 1.
Axial, T2-weighted, fat-suppressed image with color overlay demonstrates the visual standard used to classify the sites of tongue signal abnormality as involving the tip of tongue (blue shading), lateral tongue (yellow shading), or both.
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FIG 2.
Representative examples of the spectrum of TSA (arrows, A–D) observed in this study from 4 different patients in the ED. All patients were given a final clinical diagnosis of epileptic seizure. Tongue bite injuries were documented on physical examination for the patients depicted in B and D. No tongue bite injury was documented on physical examination for the patients depicted in A and C. TSA was classified as lateral only for A and C and as both lateral and tip of tongue for B and D.

Table 1:

Characteristics of the study group

	Total	TSA		P Value
	Total	Yes	No	P Value
Sex (No.)
Male	42	9	33	.80^{^a}
Female	40	10	30
Age (yr)
Mean	53.3 (19.1)	48.6 (18.5)	54.7 (19.2)	.22^{^b}
Range	20–92	20–92	20–85
Stated brain MRI indication (No.)
Seizure	49	16	33	.016^{^a}
No seizure	33	3	30
Syncope	26	2	24
Loss of consciousness	5	1	4
Fainting	2	0	2
Clinically documented tongue bite injury
Yes	15	12	3	<.001^{^a}
No	67	7	60
Final clinical diagnosis
Epileptic seizure	47	18	29	<.001^{^a}
No epileptic seizure	35	1	34
Syncope	21	0	21
Psychogenic nonepileptic seizure	2	0	2
Other	12	1^{^c}	11

↵a Fisher exact test.
↵b Student t test.
↵c Spells of altered attention, likely cognitive fluctuations in the setting of dementia.

Table 2:

Summary of T2-weighted and T2-weighted FLAIR sequences on which the tongue was evaluable within the study cohort and visibility of TSA by sequence

	Tongue Evaluable	TSA Present (%)	TSA Absent (%)	P Value^{^a}
Axial T2 FS	39	6 (15%)	33 (85%)	.73
Axial FLAIR	26	3 (12%)	23 (88%)
FS	24	2 (8%)	22 (92%)	.22
Not FS	2	1 (50%)	1 (50%)
Coronal T2 FS	8	1 (13%)	7 (87%)	.43
Coronal FLAIR	55	16 (29%)	39 (71%)
FS	44	12 (27%)	32 (73%)	.71
Not FS	11	4 (36%)	7 (64%)