Occipital Lobe Status Epilepticus, A Stroke Mimic with Novel Imaging Findings: A Case Report

Abstract

Introduction: Stroke mimics are a major diagnostic challenge during the initial evaluation of patients presenting with an acute focal neurological deficit. This case reviews a patient who presented to the emergency department (ED) with homonymous hemianopsia, a rare manifestation of focal status epilepticus of the occipital lobe. Her initial brain computed axial tomographic perfusion scan and magnetic resonance imaging revealed novel findings associated with this diagnosis. Case Report: A 70-year-old female presented to our ED with left visual field hemianopsia, dyskinesia, dysmetria, and facial droop. Her initial diagnosis was left posterior fossa circulation cerebrovascular accident. However, her neuroimaging indicated hypervascularity of the left occipital lobe without evidence of infarct or structural lesion. A cerebral angiogram excluded arteriovenous malformation. Subsequently, an electroencephalogram showed left occipital lobe status epilepticus. Conclusion: Hemianopsia is a rare presentation of focal status epilepticus mimicking stroke. Hypervascularity seen on advanced neuroimaging may have suggested this diagnosis on initial ED evaluation.

Crossed Cerebellar Diaschisis in a Status Epilepticus Patient with Stroke-Mimicking Changes: A Case Report with Suboptimal Outcome

“…Stroke-mimicking changes include various causes, such as metabolic derangements, seizures, complex migraine, central nervous system infections, sepsis, non-stroke cardiovascular events, and functional disorders. Thus, status epilepticus can mimic stroke, establishing this as a major diagnostic challenge [ 3 ].…”