Seyedmehdi Payabvash MD, Presenter: Nothing to Disclose

Alexander M. McKinney MD, Abstract Co-Author: Consultant, Toshiba Corporation

Christopher Palmer MD, Abstract Co-Author: Nothing to Disclose

Charles Loeb Truwit MD, Abstract Co-Author: Speaker, Koninklijke Philips NV Speaker, Toshiba Corporation Stockholder, Primordial Design, Inc

To determine the CTP changes in seizure patients presenting with stroke-like symptoms and its correlation with clinical presentation and EEG results.

The clinical and imaging records of all patients who presented to our emergency department with stroke-like symptoms and underwent CTP, from 1/2006 to 7/2011, were reviewed. Those patients without stroke (as per follow up imaging) who were clinically diagnosed with seizure were included. In those patients with unilateral hyperemia on CTP scan, relative CBV, CBF, and MTT of the hyperperfused regions were calculated compared to contralateral side.

From 1085 CTP examinations over 5.5 years, 21 patients were included. The average age at the time of presentation was 40 ± 12.2 years; and average time gap between the symptom onset and CTP scan was 2.3 ± 1.4 hours. Of note, 11 (52%) patients had history of prior seizure, and 9 (43%) were on antiepileptic medications at presentation. Unilateral hyperemia was found in 16 (76%) patients (10 in the left cerebral hemisphere); and the remaining 5 patients had symmetric perfusion on CTP. Temporal lobe was involved in 14/16 patients with unilateral hyperemia. Compared to patients with symmetric perfusion, those with unilateral hyperemia had higher rate of contralateral motor deficit and/or aphasia at presentation (12/16 vs 1/5. P=0.047); whereas the common presentation of those patients with symmetric perfusion scan was altered mental status (3/5 vs 1/16, p=0.028). Among those patients with unilateral hyperemia and abnormal EEG (n=13), 4/13 had unilateral fast/spike epileptiform discharge, which was associated with higher relative CBF (2 ± 0.3 vs 1.5 ± 3.7, p=0.034) and lower relative MTT (0.47 ± 0.05 vs 0.93 ± 0.34, p=0.030) compared to patients with diffuse or unilateral slowed EEG waves.

Seizure patients presenting with unilateral motor deficit or aphasia commonly have contralateral hyperemia on CTP scan; whereas, those presenting with altered mental status in the absence of lateralized motor deficit commonly have symmetric perfusion study. Moreover, lateralized fast epileptiform discharge on EEG is associated with ipsilateral high relative CBF and low MTT.

The correlation between CTP changes and clinical/EEG findings in seizure patients can potentially be used for diagnosis, prognostication, treatment follow up and therapy guidance in these patients.

Payabvash, S, McKinney, A, Palmer, C, Truwit, C, CT Perfusion (CTP) Changes in Seizure Patients Presenting with Stroke-like Symptoms: Correlation with Clinical and Electroencephalography (EEG) Findings.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014470.html