Differentiating Stroke and Seizure in Acute Setting—Perfusion Computed Tomography?

Kubiak-Balcerewicz, Katarzyna; Fiszer, Urszula; Nagańska, Ewa; Siemianowski, Cezary; Sobieszek, Aleksander; Witak-Grzybowska, Agnieszka; Kosińska-Szot, Aldona

doi:10.1016/j.jstrokecerebrovasdis.2017.02.002

Cited by 13 publications

(32 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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. The authors reported differences in only one PCT parameter (TTP) in the lateral region of the middle cerebral artery territory, but no SE‐specific PCT protocol was followed in the examination . In the present study, we exclusively included SE patients undergoing a dedicated PCT examination to analyze the perfusion changes occurring during the episode, and we found that almost 80% showed PCT abnormalities.…”

Section: Discussionmentioning

confidence: 85%

“…only one PCT parameter (TTP) in the lateral region of the middle cerebral artery territory, but no SE-specific PCT protocol was followed in the examination. 23 In the present study, we exclusively included SE patients undergoing a dedicated PCT examination to analyze the perfusion changes occurring during the episode, and we found that almost 80% showed PCT abnormalities. The perfusion changes seen in our patients were similar to those usually described for focal-onset seizures and SE; that is, cortical involvement with relative preservation of the underlying white matter.…”

Section: F I G U R E 4 Comparison Of the Perfusion Parameters Betweenmentioning

confidence: 98%

See 1 more Smart Citation

Usefulness of brain perfusion CT in focal‐onset status epilepticus

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: F I G U R E 4 Comparison Of the Perfusion Parameters Betweenmentioning

confidence: 98%

Usefulness of brain perfusion CT in focal‐onset status epilepticus

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Out of 10,105 patients treated with IVT over a period spanning from 1998 to 2017 across the participating TRISP centers, information on SaO was missing in 31 (0.3%), yielding [5][6][7][8][9][10][11][12][13][14][15], p < 0.001) and glucose levels on admission (median [IQR] = 7.1 [6.1-8.5] vs 6.6 [5.8-8.0], p = 0.016), were more often female (54.1% vs 44.6%, p = 0.027), had more often prior stroke (25.7% vs 16.5%, p = 0.005) and prior functional dependence (16.4% vs 7.6%, p < 0.001), and more often a final diagnosis of a stroke mimic (39% vs 2.1%, p < 0.001) than patients without SaO. Patients' baseline characteristics stratified to presence or absence of SaO are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…[8][9][10][11] Observational data suggest that IVT seems to be safe in patients with stroke mimics, of whom several had had seizures with postictal symptoms but without acute stroke. 7 However, differentiating between these two entities in the acute phase, when time is precious, is challenging, especially in the absence of advanced imaging.…”

mentioning

confidence: 99%

“…7 However, differentiating between these two entities in the acute phase, when time is precious, is challenging, especially in the absence of advanced imaging. [8][9][10][11] Observational data suggest that IVT seems to be safe in patients with stroke mimics, of whom several had had seizures with postictal symptoms but without acute stroke. [12][13][14][15] As these diagnoses were usually made retrospectively, the applicability in the acute management of patients presenting with SaO is limited.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Intravenous thrombolysis for suspected ischemic stroke with seizure at onset

Polymeris

Curtze

Erdur

et al. 2019

Annals of Neurology

View full text Add to dashboard Cite

for the TRISP CollaboratorsObjective: Seizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. Methods: In this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, European Cooperative Acute Stroke Study II definition), 3-month mortality, and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching, and inverse probability weighted analyses. Results: Among 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher National Institutes of Health Stroke Scale score and glucose on admission, and more often female sex, prior stroke, and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched, and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR] unadjusted = 1.53 [95% confidence interval (CI) = 0.74-3.14], OR adjusted = 0.52 [95% CI = 0.13-2.16], OR matched = 0.68 [95% CI = 0.15-3.03], OR weighted = 0.95 [95% CI = 0.39-2.32]), mortality (OR unadjusted = 1.49 [95% CI = 1.00-2.24], OR adjusted = 0.98 [95% CI = 0.5-1.92], OR matched = 1.13 [95% View this article online at wileyonlinelibrary.com.

show abstract