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The function of the claustrum and its role in neurological disorders remains a subject of interest in the field of neurology. Given the claustrum's susceptibility to seizure-induced damage, there is speculation that it could serve as a node in a dysfunctional epileptic network. This perspective article aims to address a pivotal question: Does the claustrum play a role in epilepsy? Building upon existing literature, we propose the following hypotheses for the involvement of the claustrum in epilepsy: (1) Bilateral T2/FLAIR magnetic resonance imaging (MRI) hyperintensity of the claustrum after status epilepticus represents a radiological phenomenon that signifies inflammation-related epileptogenesis; (2) The ventral claustrum is synonymous with a brain area known as 'area tempestas,' an established epileptogenic center; (3) The ventral subsector of the claustrum facilitates seizure generalization/propagation through its connections with limbic and motor-related brain structures; (4) Disruption of claustrum connections during seizures might contribute to the loss of consciousness observed in impaired awareness seizures; (5) Targeting the claustrum therapeutically could be advantageous in seizures that arise from limbic foci. Together, evidence from both clinical case reports and animal studies identify a significant role for the ventral claustrum in the generation, propagation, and intractable nature of seizures in a subset of epilepsy syndromes. [ABSTRACT FROM AUTHOR]

The claustrum sign is a neuroimaging sign that has been described as hyperintense areas that are observed in magnetic resonance imaging (MRI), in our patient it was also identified in computed tomography (CT) as hypodense areas in both claustrum. This sign has been reported in disorders associated with cytokine storms, such as COVID-19 encephalopathy, and may represent a cytokine-mediated neuroinflammation's specific marker. It is reported a case of an 8-year-old boy with COVID-19 who presented the claustrum sign, identified in CT and MRI. [ABSTRACT FROM AUTHOR]

The function of the claustrum and its role in neurological disorders remains a subject of interest in the field of neurology. Given the claustrum’s susceptibility to seizure-induced damage, there is speculation that it could serve as a node in a dysfunctional epileptic network. This perspective article aims to address a pivotal question: Does the claustrum play a role in epilepsy? Building upon existing literature, we propose the following hypotheses for the involvement of the claustrum in epilepsy: (1) Bilateral T2/FLAIR magnetic resonance imaging (MRI) hyperintensity of the claustrum after status epilepticus represents a radiological phenomenon that signifies inflammation-related epileptogenesis; (2) The ventral claustrum is synonymous with a brain area known as ‘area tempestas,’ an established epileptogenic center; (3) The ventral subsector of the claustrum facilitates seizure generalization/propagation through its connections with limbic and motor-related brain structures; (4) Disruption of claustrum connections during seizures might contribute to the loss of consciousness observed in impaired awareness seizures; (5) Targeting the claustrum therapeutically could be advantageous in seizures that arise from limbic foci. Together, evidence from both clinical case reports and animal studies identify a significant role for the ventral claustrum in the generation, propagation, and intractable nature of seizures in a subset of epilepsy syndromes.

Teaching Point: Bilateral mesiotemporal edema and the claustrum sign can be seen in febrile infection-related epilepsy syndrome (FIRES) and new onset refractory status epilepticus (NORSE) but are neither diagnostic nor pathognomonic for these entities.

Teaching Point: Bilateral mesiotemporal edema and the claustrum sign can be seen in febrile infection-related epilepsy syndrome (FIRES) and new onset refractory status epilepticus (NORSE) but are neither diagnostic nor pathognomonic for these entities. [ABSTRACT FROM AUTHOR]