Cerebral perfusion-CT patterns following seizure.
BACKGROUND
Cerebral perfusion-CT (PCT) is commonly used to image patients with suspected stroke, but PCT may also be useful in detecting abnormalities following seizure.


METHODS
We retrospectively identified patients who presented to our stroke center between 2000 and 2008 with acute, transient neurological deficits because of seizure and received PCT imaging within 72 h. We compared the group of seizure patients with abnormal post-ictal PCT to a group of seizure patients with normal post-ictal PCT. Patients were excluded from analysis if the seizure occurred secondary to an acute process known to alter cerebral perfusion.


RESULTS
Of 27 patients with acute post-ictal neurological deficits, PCT was abnormal in 10 (37%) and normal in 17 (63%). The most common post-ictal perfusion abnormality, seen in eight of 10 patients, was focal hypoperfusion, with prolonged mean transit time (MTT) and decreased cerebral blood flow and cerebral blood volume, in a cortical ribbon pattern, multi-lobar or holo-hemispheric distribution, sparing the basal ganglia. CT Angiography (CTA) showed no corresponding large vessel pathology. Two other PCT abnormalities--focal hyperperfusion and an isolated prolonged MTT--were also observed in single patients. Imaging within 2 h after seizure termination was significantly associated with finding a post-ictal PCT abnormality (P < 0.039).


CONCLUSIONS
Post-ictal cerebral PCT abnormalities are relatively common in patients early after seizure. When PCT abnormalities occur in atypical vascular distributions--and the CTA shows no corresponding large vessel occlusions--seizure should be considered as a diagnostic possibility prior to giving acute stroke therapy.
Gelfand
J M
JM
Department of Neurology, Neuroradiology Section, University of California, San Francisco, CA 94143-0114, USA.
Wintermark
M
M
Josephson
S A
SA
D000208:Acute Disease; D000368:Aged; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use; D001810:Blood Volume; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
D000927:Anticonvulsants