Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings

• Published in: Clinical radiology Vol. 70; no. 10; pp. 1136 - 1143
• Main Authors: Payabvash, S., Oswood, M.C., Truwit, C.L., McKinney, A.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2015
• Subjects: Aged; Brain - diagnostic imaging; Cerebrovascular Circulation - physiology; Electroencephalography; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Radiology; Retrospective Studies; Seizures - diagnostic imaging; Seizures - physiopathology; Tomography, X-Ray Computed - methods
• ISSN: 0009-9260; 1365-229X; 1365-229X
• DOI: 10.1016/j.crad.2015.06.078

To determine acute computed tomography perfusion (CTP) changes in seizure patients presenting with stroke-like symptoms and to correlate those changes with clinical presentation and electroencephalography (EEG). The medical records of all patients who presented to the emergency department with acute stroke-like symptoms and underwent CTP (n=1085) over a 5.5-year period were reviewed. Patients were included who had primary seizure as the final diagnosis, and underwent CTP within 3 hours of symptom onset. A subset of patients had a follow-up EEG within 7 days. The perfusion changes and EEG findings were compared between different clinical presentations. Eighteen of 1085 patients (1.7%) who underwent CTP following an acute stroke-like presentation were included. The abnormality on CTP was usually focal, unilateral hyperperfusion — increased relative cerebral blood flow (rCBF) and volume (rCBV) (n=14/18), which most often affected the temporal lobe. Those patients who presented with a motor or speech deficit (n=12) had a higher temporal lobe rCBV, and rCBF, and lower relative mean transit time (rMTT) compared to those with non-focal neurological deficit at presentation. Early EEG was available in 13 patients; a sharp-spike epileptiform EEG discharge pattern (n=5) was associated with higher temporal lobe ipsilateral rCBF and rCBV, and lower rMTT on admission CTP examination. Seizure patients who present with a unilateral motor or speech deficit most commonly have contralateral hyperperfusion in the corresponding eloquent brain regions on the acute-stage CTP examination. In such patients, epileptiform discharges on the early follow-up EEG are associated with ipsilateral hyperperfusion on the admission CTP. •Seizure patients with stroke-mimic symptoms show contralateral hyperperfusion on acute phase CTP (<3 hours of onset).•Seizure patients with unilateral paralysis/aphasia showed asymmetric perfusion compared to those with nonfocal symptoms.•Patients with sharp-spike epileptiform EEG pattern had higher rCBF and rCBV in ipsilateral temporal and parietal lobes.