Uni-hemispheric hyperperfusion in the early postictal state: case report
Open Access
- 24 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Neurology
- Vol. 20 (1), 1-5
- https://doi.org/10.1186/s12883-020-01665-9
Abstract
In the emergency setting of acute ischemic stroke, seizures have been reported in up to 4% of patients. In the absence of arterial occlusion, seizures may also cause abnormalities in CT perfusion in 78% of cases when the time window from onset to imaging is short. Both hyperperfusion and hypoperfusion in the postictal state have been described. Also, though rarely reported, postictal perfusion changes can be uni-hemispheric. In these cases, perfusion maps should be analyzed thoroughly, since perfusion reconstruction software relies heavily on a “normal” contralateral perfusion status. A 39-year-old man was found on the ground with a minor head injury. On admission, his reactions were generally slow, but there were no other neurological symptoms, and blood pressure was low. The patient had a history of primary generalized epilepsy and admitted to dropping off his anti-epileptic medication. He was transferred to the radiological department for imaging but shortly before began to experience generalized onset tonic-clonic seizures which were brought under control by intravenous therapy with 10 mg diazepam. After approximately 15 min, a multimodal CT scan was performed, revealing marked changes in the perfusion of the brain hemispheres and posterior fossa, with sharp delimitation at the midline. Blood gas analysis was congruent with respiratory acidosis. Clinically, the patient remained awake without developing any new symptoms. He gradually recovered over the following 3 h and, against our medical recommendation, discharged himself from the hospital. To the authors’ knowledge, this is the first report of an early postictal state describing sharply delimited uni-hemispheric hyperperfusion and hemispheric alteration of the cerebellum with an equally split rhombencephalon. Surprisingly, these changes were not associated with any focal neurological signs. To prevent misdiagnosis of perfusion alterations in seizures, radiologists and neurologists should be aware of the limitations of CT perfusion maps and software reconstructions. Novel use of CT perfusion reconstruction using peak enhancement helped in identifying the cerebral pathology.This publication has 16 references indexed in Scilit:
- Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findingsClinical Radiology, 2015
- The Effect of Morphine on Regional Cerebral Blood Flow Measured by 99mTc-ECD SPECT in DogsPLOS ONE, 2014
- Crossed cerebellar diaschisis: a radiological finding in status epilepticus not to missBMJ Case Reports, 2013
- Respiratory changes with seizures in localization‐related epilepsy: Analysis of periictal hypercapnia and airflow patternsEpilepsia, 2010
- Cerebral perfusion‐CT patterns following seizureEuropean Journal of Neurology, 2010
- Prevalence and correlates of epileptic seizure in substance‐abusing subjectsPsychiatry and Clinical Neurosciences, 2009
- Hypercapnia-Induced Cerebral Hyperperfusion: An Underrecognized Clinical EntityAmerican Journal of Neuroradiology, 2008
- Intraventricular Dexmedetomidine Decreases Cerebral Blood Flow During Normoxia and Hypoxia in DogsAnesthesia & Analgesia, 1997
- Intraventricular Dexmedetomidine Decreases Cerebral Blood Flow During Normoxia and Hypoxia in DogsAnesthesia & Analgesia, 1997
- Cerebral pO2, pCO2and pH: Changes During Convulsive Activity and their Significance for Spontaneous Arrest of SeizuresEpilepsia, 1972