CT perfusion: stroke, seizure or both?

Abstract

An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell’s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel disease and arterial calcification. As there were no contraindications, he received thrombolytic treatment. CT angiography and CT perfusion imaging were performed in preparation for possible thrombectomy. There was no evidence of a large vessel thrombus, and changes on CT perfusion were suggestive of seizure activity, with relative hyperperfusion on the cerebral hemisphere of interest. Post thrombolysis, his NIHSS was 5. An MR scan revealed evidence of bilateral thalamic infarcts. After a period of rehabilitation, he was discharged home and independently mobile but with cognitive impairment.Acute stroke care increasingly uses multimodal imaging to confirm the clinical diagnosis and help optimise initial emergency management. Such imaging is useful in determining whether the presentation is a vascular event or stroke mimic. Moreover, seizures complicate and mimic acute strokes, which can lead to therapeutic uncertainty. This case highlights the increasingly sophisticated investigation of patients presenting with suspected acute stroke, with the attendant need for accurate interpretation by experienced clinicians.

Core and penumbra estimation using deep learning-based AIF in association with clinical measures in computed tomography perfusion (CTP)

“…In patient cohort with acute focal neurological impairments, it is crucial to quickly identify stroke mimics, such as seizures [ 38 ]. Major use of CTP is to identify stroke patients who may benefit from reperfusion therapy [ 32 ].…”

“…Major use of CTP is to identify stroke patients who may benefit from reperfusion therapy [ 32 ]. Recent studies suggested CT perfusion as a promising tool for determining the cause of seizures [ 38 ]. The present study has been done on limited CTP dataset of ischemic stroke patients.…”

Recommendations for prescribing pharmacologic prevention during emergency department treatment of epileptic seizures

“…Puede evitarse cuando existe un claro origen tóxico-metabólico actual o neuroimagen clarifica-dora reciente. La TC multimodal, disponible por el momento en el código ictus, incluye TC de perfusión que en pacientes sin lesión congruente con ictus ha permitido identificar áreas de aumento de flujo o retardo, que ayudan al diagnóstico urgente de CE 43 . La punción lumbar se recomienda ante sospecha de crisis secundarias a infecciones del sistema nervioso central (SNC) o hemorragia subaracnoidea tras fondo de ojo normal o TC no concluyente.…”