Identifying status epilepticus from acute ischemic stroke by brain CT perfusion :two case reports
Xiao Yi-Yang , MD 1 , Hsu Chung-Fu , MD 1 ,
1 Department of Neurology , Chung Shan Medical University Hospital
Chi Hsin Yi , PhD, MD
Department of Neurology , Chung Shan Medical University Hospital
MATERIAL and METHOD:
Case 1 : A 61y/o female was sent to emergent department (ED)due to acute onset of left side weakness and consciousness disturbance. Non contrast brain computerized tomography (CT) performed did not find any brain lesions. This patient received recombinant tissue plasminogen activator (rt-PA ) then . Later, her brain CT perfusion completed and increased perfusion over the right frontal-parietal lobes was noted. One episode of generalized tonic clonic seizure developed a half one hour after rt-PA injection. We added anti-epileptic drugs (AED) for seizure control . Two hours later, all the neurological deficits subsided. Her brain MRI followed on the next day did not find any infarction lesions . Case 2 : A 79 y/o female was sent to our ED due to acute onset of left side weakness and consciousness disturbance; mechanical thrombectomy was considered according to clinical history. Non-contrast brain CT did not find compatible new lesions ;her brain CT perfusion completed with preserved intracranial arteries; increased perfusion over the right frontal-temporal lobes was noted .According to this finding, we added AED for seizure control and arranged electroencephalography ,which revealed periodic lateralized epileptiform discharges(PLED) over right hemisphere ; her consciousness and weakness improved after treatment.
Seizure is difficult to differentiate from ischemic stroke by the clinical presentation and non-contrast brain alone. However, recognizing seizure is important for the following treatment to conduct thrombolysis, mechanical thrombectomy or anticonvulsant drugs. Analyzing the different parameters of brain CT perfusion helped to identify stroke mimics and choose the correct treatment plans.