title: Epileptic Ictal Hyperperfusion on Arterial Spin Labeling Perfusion and Diffusion-Weighted Magnetic Resonance Images in Posterior Reversible Encephalopathy Syndrome.
abstract: BACKGROUND
  The hemodynamic state of the posterior dominant vasogenic edema in posterior reversible encephalopathy syndrome (PRES) is controversial. The aim of this retrospective study was to examine the contribution of epileptic ictal hyperperfusion in patients with PRES using combined magnetic resonance perfusion imaging with arterial spin labeling (ASL) and diffusion-weighted magnetic resonance imaging (MRI).
  
  
  METHODS
  A detailed review of chronological MRI findings in 2 patients, including diffusion-weighted imaging (DWI) and ASL, with special reference to clinical and electroencephalographic findings, was performed. At the onset of PRES, both patients developed secondary generalized seizures.
  
  
  RESULTS
  At the first PRES episode in Case 1, ASL and DWI clearly depicted "ictal hyperperfusion" and prolonged epilepsy-induced cytotoxic edema in the left parieto-occipital lobe cortex, located around the vasogenic edema of the PRES lesion in the left occipital lobe (hypoperfused area). At the second and third episodes (2 and 7 months after the first episode, respectively), although recurrent PRES was ruled out, ASL and DWI clearly demonstrated ictal hyperperfusion in the left posterior temporal and parieto-occipital lobes associated with partial nonconvulsive status epilepticus, which developed around the PRES-related old hematoma lesion. In Case 2, peri-ictal MRI findings of ictal ASL hyperperfusion and cortical hyperintensity on DWI were also noted in the left parieto-occipital lobe, but were mild compared with Case 1.
  
  
  CONCLUSIONS
  Combined use of DWI and ASL can provide information on hemodynamic state associated with epileptic ictal hyperperfusion in the various phases of PRES.
authors.affiliation: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Wakisaka
authors.affiliation: Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan; Department of Neurosurgery, Kyushu Rosai Hospital, Kikakyushu, Japan.
authors.forename: Takato
authors.initials: T
authors.lastname: Morioka
authors.affiliation: Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan; Department of Neurosurgery, Kyushu Rosai Hospital, Kikakyushu, Japan. Electronic address: shimogawa28@gmail.com.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Shimogawa
authors.affiliation: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Murao
authors.affiliation: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kanazawa
authors.affiliation: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hagiwara
authors.affiliation: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Arakawa
mesh_terms: D000328:Adult; D002536:Cerebral Arteries / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000473:pathology*; D012008:Recurrence; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: Stroke mimics; arterial spin labeling; diffusion-weighted image; ictal hyperperfusion; nonconvulsive status epilepticus