title: Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Payabvash
authors.affiliation: Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Oswood
authors.affiliation: Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Truwit
authors.affiliation: Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA. Electronic address: mckinrad@umn.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: McKinney
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*