Hyperperfusion in CT-perfusion scan indicating focal status epilepticus
Purpose: To demonstrate hyperperfusion in the region with epileptic activity during focal status epilepticus by CT-perfusion
Method: Clinical case report including EEG documentation, CT-perfusion, CT-angiography and conventional MRI
Results: A 83-year old man with craniocerebral injury was admitted with the tentative diagnosis of stroke due to right hemiparesis and speech arrest. Morphological CCT revealed microangiopathy and generalized volume-reduction without early signs of ischemia or cerebral haemorrhage.
CCT perfusion scan however did not show the expected localized hypoperfusion but hyperperfusion in the posterior supply area of the left medial cerebral artery (MCA). Several minutes later, the patient developed rhythmic cloni of the right arm and eye deviation to the right. EEG then revealed continuous rhythmic activity in the left posterior region suggesting focal status epilepticus (SE). The status was terminated by i.v. valproate. The right hemiparesis (Todd's paresis) was fully reversible within 2 days.
Conclusion: Localized hyperperfusion as detected by CCT perfusion scan in patients with negative neurological symptoms (such as hemiparesis and aphasia) may suggest focal status epilepticus in the absence of positive clinical signs such as clonic or tonic motor activity.