Local cortical hypoperfusion imaged with CT perfusion during postictal Todd’s paresis

Mathews, Marlon S.; Smith, Wade S.; Wintermark, Max; Dillon, William P.; Binder, Devin K.

doi:10.1007/s00234-008-0362-1

Cited by 68 publications

(55 citation statements)

References 24 publications

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“…Another important differential diagnosis for stroke mimics, postictal focal deficit (Todd's paresis), which would have warranted electroencephalography (EEG) after imaging, was abandoned as the decisive clues became available by the mother's information. The role of PCT in epileptogenic conditions is yet unclear, as both hypoperfusion and hyperperfusion have been demonstrated in case reports, possibly depending on whether the underlying pathophysiology was truly postictal or focal status epilepticus, respectively [8,9]. …”

Section: Discussionmentioning

confidence: 99%

Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura

Angermaier¹,

Langner²,

Kirsch³

et al. 2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Migraine with aura is defined as a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually, last for less than 60 minutes and is followed by characteristic headache and vegetative symptoms. Acute aphasia is a well-known aura symptom. We present a case of an acute focal neurologic deficit in which perfusion imaging proved helpful in rapid decision making for the appropriate treatment by identifying the syndrome as a stroke mimic. Case Report: A 24-year-old male student was admitted with global aphasia and headache precluding any interview for the patient's medical history. Initial perfusion computed tomography scan showed hypoperfusion in the entire left hemisphere, pronounced in the left occipitotemporal lobe and Broca's area. This pattern which was not restricted to a vascular territory and hypoperfusion above critical ischemia guided us in classifying the deficit as a stroke mimic, specifically as migraine aura. Conclusion:In the hyperacute phase of stroke-like symptoms, multimodal computed tomography scan can add valuable information for differentiating ischemic stroke from stroke mimics and support treatment decision-making.

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Section: Discussionmentioning

confidence: 99%

Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura

Angermaier¹,

Langner²,

Kirsch³

et al. 2014

IJCRI

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“…22,27 Beyond hypoperfusion, the pattern of perfusion alterations differed from those of NCSE in that both cortical and subcortical regions were involved. Subcortical hypoperfusion is in agreement with previous single-photon emission CT (SPECT) studies.…”

Section: Visual Analysis In Postictal Statesmentioning

confidence: 99%

Cortical Regional Hyperperfusion in Nonconvulsive Status Epilepticus Measured by Dynamic Brain Perfusion CT

Hauf¹,

Slotboom²,

Nirkko³

et al. 2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Nonconvulsive status epilepticus (NCSE) is associated with a mortality rate of up to 18%, therefore requiring prompt diagnosis and treatment. Our aim was to evaluate the diagnostic value of perfusion CT (PCT) in the differential diagnosis of NCSE versus postictal states in patients presenting with persistent altered mental states after a preceding epileptic seizure. We hypothesized that regional cortical hyperperfusion can be measured by PCT in patients with NCSE, whereas it is not present in postictal states.

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“…It is estimated that between 5 to 30% of cases identified as "brain attacks" are, in fact, due to stroke-mimicking conditions (5,6). Of these, seizure-related neurologic deficits with associated neuroimaging findings are well-known as great mimics of ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, seizure-related neurologic deficits with associated neuroimaging findings are well-known as great mimics of ischemic stroke. However, the exact pathophysiologic explanation of seizure-related changes has not yet been established (6). Many possible mechanisms account for the periictal state, including neurotransmitter depletion, neuronal desensitization, alteration of local CBF, and various kinds of active inhibition, for which the utility of multiple imaging modalities have been investigated in previous studies (7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

Kim

Baek

Choi

et al. 2017

Investig Magn Reson Imaging

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Original ArticlePurpose: This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period. Materials and Methods: From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions. Results: All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities. Conclusion: Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

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Local cortical hypoperfusion imaged with CT perfusion during postictal Todd’s paresis

Cited by 68 publications

References 24 publications

Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura

Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura

Cortical Regional Hyperperfusion in Nonconvulsive Status Epilepticus Measured by Dynamic Brain Perfusion CT

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

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