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Free Content Camping Out in the Hippocampus: Imaging Spectrum of Etiologies That Affect the Hippocampi and Tips for Honing the Differential Diagnosis

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The hippocampus is a complex anatomic structure characterized by interlocking folds of gray matter situated within the medial temporal lobes. As a crucial structure within the limbic system, it plays a vital role in memory formation and emotional decision-making. The hippocampi are susceptible to a heterogenous spectrum of pathologies related but not limited to degenerative, ischemic, drug-related, infectious, metabolic, autoimmune-mediated, and neoplastic etiologies. These include hippocampal sclerosis, Alzheimer disease and frontotemporal dementia, transient global amnesia, herpes simplex encephalitis, mitochondrial encephalopathy with lactic acidosis and strokelike episodes, ischemic and hemorrhagic infarction, seizure-related edema, autoimmune and paraneoplastic limbic encephalitis, and gliomatous lesions. Although imaging findings for some of these entities often overlap, which renders them potentially difficult to distinguish from one another, attention to both the imaging and clinical findings is important in narrowing the differential diagnosis.

Learning Objectives: To (1) review the normal hippocampal anatomy, function, and development; (2) recognize common hippocampal pathologies by reviewing original cases that illustrate the spectrum of hippocampal disease; and (3) become aware of the potential pitfalls, variants, and developmental anomalies related to the hippocampus that may confound evaluation for pathology.
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Keywords: FTLD = frontotemporal lobar degeneration; GABAr = γ-aminobutyric acid receptor; GAD = glutamic acid decarboxylase; HSV = herpes simplex virus; MELAS = mitochondrial encephalopathy, lactic acidosis, and stroke like episode; MTA = mesial temporal atrophy; NMDAr = N-methyl D-aspartate receptor; TGA = transient global amnesia; VGKC = voltage-gated potassium channel

Document Type: Research Article

Publication date: 01 February 2019

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  • Neurographics is the peer-reviewed, bimonthly educational journal of the American Society of Neuroradiology. The journal comprises articles selected from material presented at the ASNR Annual Meeting. Neurographics also publishes other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Neurographics offers CME credit for reading review articles and completing quiz-based self-assessment activities. CME credit for review articles may be claimed up to 3 years after an article's publication date. Visit https://members.asnr.org/webcast/content/course_list.asp?src=Neurographics to view all available CME courses.
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