Introduction: Computed tomography perfusion (CTP) imaging permits rapid semi-quantitative assessment of regional brain blood flow in patients with stroke and cerebrovascular disease. Its role in the diagnosis of seizures is unclear and previous reports are mixed.
Methods: We performed a two-year retrospective review of patients with a clinical diagnosis of seizures who underwent CTP imaging during workup of post-ictal deficits presenting as possible stroke. A total of 65 patients were found and those with known previous strokes or old perfusion deficits were excluded (n=11).
Results: Most patients who were eventually diagnosed as having seizures had normal CTP images; only 10 patients (19%) had abnormal scans (6 with hyperperfusion and 4 with hypoperfusion). Patients who were scanned within a shorter time interval from seizure onset were significantly more likely to have hyperperfusion (p<0.05). All of the patients with hyperperfusion were found to have ongoing seizure activity on EEG.
Conclusions: CTP is an excellent diagnostic study to rule out ischemic pathology but may often be normal in patients with seizure. This may be related to the interval between seizure ictus and CTP. However, a finding of paradoxical hyperperfusion rather than hypoperfusion on CTP in a patient with neurological deficit should prompt suspicion of ongoing seizure activity.
Patient Care: Increase the understanding of computed tomography perfusion imaging in patients with seizures.
Learning Objectives: 1. Discussion of CTP findings during seizure ictus and post-ictal states
2. Describe the management algorithm for patients with hyperperfusion on CTP imaging and stroke like symptoms