Nonconvulsive partial status epilepticus mimicking recurrent infarction revealed by diffusion-weighted and arterial spin labeling perfusion magnetic resonance images.
"Non-convulsive" partial status epilepticus (SE) is an important pathologic condition that should be differentiated from cerebral infarction. Herein, we reported 2 patients who had partial SE associated with old infarction in the right parietal lobe. Each patient had 2 episodes of left hemiparesis and hemisensory disturbance without convulsion. On diffusion-weighted magnetic resonance images (DW-MRI), a hyperintense lesion was noted in the cortex around the old infarction lesion, and recurrent infarction was suspected. Although electroencephalography (EEG) failed to reveal ictal discharges or interictal paroxysmal activities in 3 of 4 episodes, perfusion images with arterial spin labeling (ASL) clearly demonstrated ictal hyperperfusion in the area corresponding to the cortical hyperintense lesion on DW-MRI. After appropriate anticonvulsant treatment based on the diagnosis of partial SE, clinical symptoms were completely improved. These data stress the importance of cortical hyperintensity on DW-MRI and ictal ASL hyperperfusion, even when SE cannot be determined from EEG.
Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan. Electronic address: yuka8850@gmail.com.
Yuka
Y
Kanazawa
Department of Neurosurgery Kyushu Rosai Hospital, Kitakyushu, Japan.
Takato
T
Morioka
Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
Shuji
S
Arakawa
Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
Yoshihiko
Y
Furuta
Department of Radiology, Kyushu Rosai Hospital, Kitakyushu, Japan.
Asako
A
Nakanishi
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Takanari
T
Kitazono
D000368:Aged; D020520:Brain Infarction / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D013113:Spin Labels; D013226:Status Epilepticus / Q000175:diagnosis*
D013113:Spin Labels
Stroke mimics; arterial spin labeling; diffusion-weighted image; ictal hyperperfusion; nonconvulsive status epilepticus