The role of CT perfusion in the evaluation of seizures, the post-ictal state, and status epilepticus

Gugger, James J; Llinás, Rafael H.; Kaplan, Peter W.

doi:10.1016/j.eplepsyres.2019.106256

Cited by 20 publications

(31 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nearly two-thirds of the patients ultimately diagnosed with SE showed focal hyperperfusion on pCT, while those diagnosed with a single epileptic seizure mostly showed normal brain perfusion. These findings are consistent with previous reports of brain hemodynamics during SE and post-ictal states in similar settings [17].…”

Section: Discussionsupporting

confidence: 94%

“…An electroencephalogram acquired within 2 h of neuroimaging (E, ten seconds-epoch longitudinal bipolar montage) showed focal electrographic status epilepticus in the left fronto-central region without motor prominent symptoms. A second electroencephalogram performed 20 h later (F) showed left fronto-central periodic lateralized discharges without modifiers similar results to ours [17]; thus, pCT seems not useful regarding the diagnostic process of single epileptic seizures. In addition, none of the patients with hypoperfusion on pCT in our study were diagnosed with SE.…”

Section: Discussionsupporting

confidence: 76%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 76%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…normal sein. Zur Nutzung anderer perfusionsbasierter Techniken wie Arterial-Spin-Labeling (ASL) und Perfusions-MRT gibt es bisher nur vereinzelte Fallberichte, sodass der Einsatz der perfusionsbasierten Messungen momentan keinen Stellenwert in der klinischen Praxis hat und noch weiter untersucht werden sollte [ 49 ].…”

Section: Diagnostikunclassified

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

Rosenow

Weber

2021

Nervenarzt

View full text Add to dashboard Cite

ZusammenfassungDiese S2k-Leitlinie (LL) zum Status epilepticus (SE) im Erwachsenenalter schreibt die letzte DGN-LL zum SE von 2012 fort. Neue Definitionen und Evidenz wurden bei der Erstellung der LL und des Clinical Pathway berücksichtigt. Jeder epileptische Anfall, der länger als 5 Minuten anhält (oder ≥ 2 Anfälle über einen Zeitraum von mehr als 5 Minuten ohne Wiedererlangen des neurologischen Ausgangsstatus), soll als SE behandelt werden.In der Diagnostik sollte initial eine CCT oder, wenn möglich, eine MRT erfolgen. Das EEG spielt bei der Diagnosestellung und beim Therapiemonitoring von non-konvulsiven SE und zum Ausschluss bzw. Nachweis psychogener nichtepileptischer Anfälle eine wesentliche Rolle. Der prognostische Einfluss von insbesondere entzündlichen Begleiterkrankungen (z. B. Pneumonie) wurde besser belegt, weshalb entsprechende Laborparameter auch im Verlauf kontrolliert werden sollten und ggf. frühzeitig eine antibiotische Therapie initiiert werden sollte.Die Therapie erfolgt in 4 Stufen: 1. Initialer SE: Gabe eines ausreichend hoch dosierten Benzodiazepins i. m., i. v. oder i. n.; 2. Benzodiazepin-refraktärer SE: 1. Wahl ist die i.v. Gabe von Levetiracetam oder Valproat; 3. Refraktärer SE (RSE) und 4. Superrefraktärer SE (SRSE): I.v. Propofol oder Midazolam alleine oder in Kombination oder Thiopental in anästhetischen Dosen. Beim fokalen non-konvulsiven RSE kann unter Umständen auf die Einleitung eines therapeutischen Komas verzichtet werden. Bei SRSE sollte die ketogene Diät zum Einsatz kommen. I.v. Ketamin oder inhalatives Isofluran kann erwogen werden. In Einzelfällen kann die elektrokonvulsive Therapie und, bei resektabler epileptogener Zone, ein Epilepsie chirurgischer Eingriff erwogen werden. I.v. Allopregnanolon oder die Hyperthermie sollen nicht eingesetzt werden.

show abstract

“…7 Cerebral perfusion imaging related to acute ischemic stroke has been widely investigated, 8 but few studies on the role of cerebral perfusion imaging in seizure diagnosis have been published. 9,10 During the ictal period, neuronal activation may be associated with an increase in regional brain perfusion, whereas the postictal period is characterized more frequently by hypoperfusion. 11,12 The aim of our study was to identify cerebral perfusion imaging patterns that help differentiate an acute focal neurologic deficit related to an epileptic seizure from an acute ischemic stroke in code stroke alerts, in the absence of vessel occlusion or stenosis on CTA.…”

mentioning

confidence: 99%

Acute Ischemic Stroke or Epileptic Seizure? Yield of CT Perfusion in a “Code Stroke” Situation

Lucas

Gariel²,

Ménégon³

et al. 2021

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:The clinical differentiation between acute ischemic stroke and epileptic seizure may be challenging, and making the correct diagnosis could avoid unnecessary reperfusion therapy. We examined the accuracy of CTP in discriminating epileptic seizures from acute ischemic stroke without identified arterial occlusion. MATERIALS AND METHODS:We retrospectively identified consecutive patients in our emergency department who underwent CTP in the 4.5 hours following the development of an acute focal neurologic deficit who were discharged with a final diagnosis of acute ischemic stroke or epileptic seizure.RESULTS: Among 95 patients, the final diagnosis was epileptic seizure in 45 and acute ischemic stroke in 50. CTP findings were abnormal in 73% of the patients with epileptic seizure and 40% of those with acute ischemic stroke. Hyperperfusion was observed more frequently in the seizure group (36% versus 2% for acute ischemic stroke) with high specificity (98%) but low sensitivity (35%) for the diagnosis of epileptic seizure. Hypoperfusion was found in 38% of cases in each group and was not confined to a vascular territory in 24% of patients in the seizure group and 2% in the acute ischemic stroke group. The interobserver agreement was good (k ¼ 0.60) for hypo-, hyper-, and normoperfusion patterns and moderate (k ¼ 0.41) for the evaluation of vascular systematization.CONCLUSIONS: CTP patterns helped to differentiate acute ischemic stroke from epileptic seizure in a "code stroke" situation. Our results indicate that a hyperperfusion pattern, especially if not restricted to a vascular territory, may suggest reconsideration of intravenous thrombolysis therapy. ABBREVIATIONS: AIS ¼ acute ischemic stroke; EEG ¼ electroencephalography; NPV ¼ negative predictive value; PPV ¼ positive predictive value; Tmax ¼ time-to-maximum "C ode stroke" status, a sudden-onset neurologic deficit, is a common cause of admission to emergency departments. Stroke is the first diagnosis to explore because it requires early reperfusion therapy such as thrombolysis and/or mechanical thrombectomy because as many as 30% of patients with code stroke involve conditions that mimic stroke, 1 with epileptic seizure being one of the most frequent ($10%). 2 Up to 15% of patients

show abstract

The role of CT perfusion in the evaluation of seizures, the post-ictal state, and status epilepticus

Cited by 20 publications

References 33 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

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

Acute Ischemic Stroke or Epileptic Seizure? Yield of CT Perfusion in a “Code Stroke” Situation

Contact Info

Product

Resources

About