title: Usefulness of multiparametric computerized tomography findings in the differential diagnosis of stroke mimics of epileptic origin: A preliminary study.
abstract: OBJECTIVE
  Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events.
  
  
  METHODS
  We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy.
  
  
  RESULTS
  The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities.
  
  
  CONCLUSIONS
  The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation.
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España. Electronic address: roci.lopez.ruiz@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: López Ruiz
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Quintas
authors.affiliation: Servicio de Radiología, Sección de Neurorradiología, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: Largo
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: de Toledo
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: M T
authors.initials: MT
authors.lastname: Carreras
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Gago-Veiga
authors.affiliation: Servicio de Radiología, Sección de Neurorradiología, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Manzanares
authors.affiliation: Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Vivancos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cerebral perfusion Computerized Tomography; Epilepsia; Epilepsy; Ictus; Multiparametric Computerized Tomography; Stroke; Stroke mimics; Tomografía computarizada multiparamétrica; Tomografía computarizada perfusión