Advanced CT for diagnosis of seizure-related stroke mimics

Austein, Friederike; Huhndorf, Monika; Meyne, Johannes; Laufs, Helmut; Jansen, Olav; Lindner, Thomas

doi:10.1007/s00330-017-5174-4

Cited by 26 publications

(33 citation statements)

References 35 publications

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“…Since CTP is now performed in acute setting as a part of stroke code, more CTPs are done during seizure and hyperperfusion of epileptogenic foci is more common than hypoperfusion. In one recent CTP study in "code stroke" patients, about 60% of seizure patients with stroke like symptoms showed hyperperfusion in the involved hemisphere (5). The radiologist should be aware of increased perfusion in epileptogenic foci and not interpret the contralateral hemisphere as ischemic.…”

Section: Discussionmentioning

confidence: 99%

“…epileptogenic foci (5,7,8). In one prior published study, patients with epilepsy (and without infarction) were eval- perfusion with focal hypo perfusion with prolonged MTT and decreased CBV and CBF being the most common finding followed by hollo-hemispheric hypo perfusion, multilobar hypo perfusion and 'cortical ribbon' pattern (6).…”

Section: Discussionmentioning

confidence: 99%

“…There are several diseases that can mimic stroke (5). Stroke mimics can occur in up to 19% of patients initially treated for stroke and in up to 16.7% of patients receiving thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

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Status Epilepticus, Hemispheric Confusion, a CT Perfusion Pitfall in “Code Stroke” Patients: A Case Report

Sotoudeh

2018

Iran J Radiol

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CT perfusion (CTP) is an evolving protocol for stroke evaluation in many hospitals, but there are several pitfalls in CT perfusion. Herein I present a patient suspicious of brain infarction under "stroke code". CT perfusion was initially visually interpreted and because of obvious asymmetry between the right and left cerebral hemispheres the interpretation was consistent with right cerebral ischemia. CT angiogram (CTA) did not demonstrate significant vascular stenosis. Subsequent electroencephalography (EEG) was consistent with status epilepticus from the left cerebral hemisphere. Since more and more CTPs are now performed in acute setting of code stroke more patients are being imaged with ongoing seizure with increased perfusion in epileptogenic brain parenchyma. This is different from the conventional concept of hypo perfusion of the involved brain in CTP performed in the "post-ictal" phase. The interpreting radiologist should be informed about the patient symptoms and should avoid solo visual assessment of CT perfusion in patients under the "stroke code". Keyword(s) s

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Status Epilepticus, Hemispheric Confusion, a CT Perfusion Pitfall in “Code Stroke” Patients: A Case Report

Sotoudeh

2018

Iran J Radiol

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“…Previous studies focusing on the usefulness of PCT in SE are mainly retrospective and involve patients who underwent this examination for suspected stroke, but were ultimately diagnosed with SE . To our knowledge, there is only one available prospective study that aimed to differentiate between the perfusion patterns of strokes and seizures based on a prompt PCT study.…”

Section: Discussionmentioning

confidence: 99%

“…On visual inspection of the raw PCT images, hyperperfusion was defined as an increase in the rCBF and a decrease in the TTP and MTT in the maps, whereas hypoperfusion was defined as focally decreased rCBF and increased TTP and MTT relative to the healthy side (defined based on clinical and EEG criteria) …”

Section: Methodsmentioning

confidence: 99%

Usefulness of brain perfusion CT in focal‐onset status epilepticus

et al. 2019

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Objective To evaluate the perfusion computed tomography (PCT) patterns in patients with status epilepticus (SE). Methods We included consecutive SE patients, diagnosed by ictal encephalography (EEG) findings and clinical semiology, who prospectively underwent a dedicated PCT study of SE in the ictal phase. The perfusion maps were visually analyzed. For the quantitative assessment, regions of interest in areas where the maps suggested abnormalities were compared with the corresponding area in the unaffected contralateral cortex. Asymmetry indices between affected and unaffected hemispheres were calculated for the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), time to peak (TTP), and mean transit time (MTT). Nine patients underwent a follow‐up PCT after SE resolution, and the corresponding maps were compared to the ictal maps. In addition, we included a control group of 10 sex‐ and age‐matched patients with SE mimics or postictal phenomena, who also underwent acute PCT during the study period. Results The study included 19 patients: mean age 69.47 ± (standard deviation) 15.9 years, 68.4% men. On visual analysis of parametric perfusion maps during the ictal phase, regional cortical hyperperfusion was depicted in 78.9% of patients. Quantitative analysis showed significantly increased rCBF (P = 0.002) and rCBV (P = 0.004) values and decreased TTP (P < 0.001) and MTT (P = 0.001) in cortical areas of the affected vs the unaffected side. The mean asymmetry index was 12.8 for rCBF, 13.7 for rCBV, −3.0 for TTP, and −3.7 for MMT. In the nine patients with a follow‐up PCT, eight showed decreased intensity, rCBV (P = 0.035), and rCBF (P = 0.024) in the hyperperfusion areas. The sensitivity of hyperperfusion detection for the diagnosis of SE was 78.95%, specificity 90%, positive predictive value 93.75%, and negative predictive value 69.23%. Comparative quantitative analysis of asymmetry indices for rCBF, rCBV, and MTT between ictal PCT and control patients showed significant differences for all parameters (rCBF P = 0.001; rCBV P = 0.002; TTP P = 0.001; and MTT P = 0.001). Significance Visual and quantitative analysis of perfusion maps detects regional hyperperfusion in SE patients with good diagnostic capability. Perfusion was increased in PCT maps of the affected cerebral hemisphere as compared to the contralateral region during the ictal phase. PCT may provide valuable diagnostic information in patients with SE and complement the diagnostic value of EEG.

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Case series demonstrating the value of computed tomography perfusion in differentiating ischemic strokes from seizures in patients with isolated aphasia

2021

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Advanced CT for diagnosis of seizure-related stroke mimics

Abstract: • Advanced CT helps to differentiate between ischaemic strokes and stroke mimics. • Seizure-related perfusion patterns are distinct from ischaemia hypoperfusion. • Advanced CT could improve rapid adequate treatment for AIS and seizure events.

Cited by 26 publications

References 35 publications

Status Epilepticus, Hemispheric Confusion, a CT Perfusion Pitfall in “Code Stroke” Patients: A Case Report

Status Epilepticus, Hemispheric Confusion, a CT Perfusion Pitfall in “Code Stroke” Patients: A Case Report

Usefulness of brain perfusion CT in focal‐onset status epilepticus

Case series demonstrating the value of computed tomography perfusion in differentiating ischemic strokes from seizures in patients with isolated aphasia

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