Role of 3D Pseudocontinuous Arterial Spin-Labeling Perfusion in the Diagnosis and Follow-Up in Patients with Herpes Simplex Encephalitis

Li, R.; Shi, Peilin; Liu, T.-F.; Li, Y.; Wang, Y.; Wu, Kaiyi; Chen, X.-J.; Xiao, Hua-Feng; Wang, Y.-L.; Ma, Lin; Lou, Xin

doi:10.3174/ajnr.a6279

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…In addition, longer, continuous EEG recordings in the ER could improve the characterization of patients along the ictal-interictal continuum and its neuroimaging correlate obtained on pCT. Another limitation of our study is that we did not investigate the diagnostic specificity of pCT by comparing results between patients diagnosed with SE and controls with other conditions likely to cause cerebral hyperemia, such as encephalitis [31]. In addition, in light of the presented results, further studies could assess pCT imaging usefulness to differentiate between SE, and other acute presenting non-ictal mimics, such as confusional or dissociative psychogenic states.…”

Section: Discussionmentioning

confidence: 95%

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

et al. 2022

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Background Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. Methods We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. ResultsWe included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4-80.2) and a specificity of 77.8% (95% CI 57.2-90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. Conclusions In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.

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Section: Discussionmentioning

confidence: 95%

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

et al. 2022

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“… Mean ± SD for 7 GC cases: 1.02 ± 0.42 Seizures (50%), headache (36%), cognitive decline (32%), focal motor deficits (32%), cerebellar symptoms (21%), visual disturbance and papilledema due to raised ICP (15%), behavioral change (13%), psychiatric symptoms (8%) Nonspecific may be normal or mild pleocytosis, increased protein level and raised opening pressure may be present. HSV Encephalitis [47] , [48] , [49] , [50] , [51] , [52] , [53] In immunocompetent patients, unilateral or asymmetrically bilateral involvement of medial temporal lobes, inferolateral frontal lobes, insular cortexes, and cingulate gyrus occurs (with sparing of basal ganglia). Mammillary bodies, hypothalamus, and diffuse white matter involvement is a rare condition but is possible.…”

Section: Discussionmentioning

confidence: 99%

Gliomatosis cerebri with blindness: A case report with literature review

Jahanshahi

Salarinejad

Oraee‐Yazdani

et al. 2023

Radiology Case Reports

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“…Different from the higher CBF in patients with herpes simplex encephalitis at the acute stage, 7 AE is one of the emergent causes of subacute changes caused by antibodies. CSF analysis and MR imaging could reveal inflammatory changes.…”

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confidence: 95%

Regarding “Brain Perfusion Alterations on 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in Patients with Autoimmune Encephalitis: A Case Series and Literature Review”

Zhang

Zheng

Huang

2022

AJNR Am J Neuroradiol

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W e read with interest the article by Li et al, "Brain Perfusion Alterations on 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in Patients with Autoimmune Encephalitis: A Case Series and Literature Review," recently published in the American Journal of Neuroradiology. In this retrospective case series, the authors found that all patients with autoimmune encephalitis (AE) had increased CBF in the inflammatory area. 1 Indeed, arterial spin-labeling (ASL) is critical in the diagnosis of AE and may serve as early evidence preceding conventional abnormal findings on MR imaging and laboratory diagnosis. Sachs et al 2 found cerebral hyperperfusion in anti-N-methyl-D-aspartate (NMDAR) encephalitis. Vallabhaneni et al 3 demonstrated increased CBF and CBV in the left parieto-occipital gray matter on CT perfusion. Sarria-Estrada et al 4 revealed ASL hyperperfusion overlapping the involved lesions, but they also found increased perfusion and increased metabolism on [ 18 F] FDG-PET/CT and SPECT in paraneoplastic autoimmune encephalitis.As mentioned above, 4 we have also encountered several cases of AE with hypoperfusion or without any visible changes on ASL perfusion in clinical practice. We retrospectively reviewed image data from 30 consecutive patients with AE in the most recent 2 years including major constituents of AE-covered anti-NMDAR (11 patients), anti-leucine-rich glioma inactivated-1 (5 patients), anti-G-protein coupled receptor for gamma-aminobutyric acid receptor (4 patients), anti-myelin oligodendrocyte glycoprotein antibody associated encephalitis (3 patients), anti-contactin-associated protein-like 2 antibody-associated disease (3 patients), Hashimoto encephalopathy (2 patients), anti-glutamic acid decarboxylase-65 AE (1 patient), and anti-CV2 AE (1 patient). All MR imaging of our patients was also performed on a 3T MR imaging scanner (Discovery 750; GE Healthcare) with a 3D ASL sequence. Seven patients had visible infected lesions with increased perfusion on ASL, 5 patients showed asymmetric changes across brain regions without intracranial lesions on T2 FLAIR, and 2 patients presented with decreased perfusion with visible infected focus, while the rest

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Role of 3D Pseudocontinuous Arterial Spin-Labeling Perfusion in the Diagnosis and Follow-Up in Patients with Herpes Simplex Encephalitis

Cited by 6 publications

References 31 publications

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

Gliomatosis cerebri with blindness: A case report with literature review

Regarding “Brain Perfusion Alterations on 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in Patients with Autoimmune Encephalitis: A Case Series and Literature Review”

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