R López Ruiz1, S Quintas2, P Largo3, M de Toledo2, M T Carreras2, A Gago-Veiga2, R Manzanares3, J Vivancos2. 1. Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España. Electronic address: roci.lopez.ruiz@gmail.com. 2. Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de La Princesa, Madrid, España. 3. Servicio de Radiología, Sección de Neurorradiología, Hospital Universitario de La Princesa, Madrid, España.
Abstract
OBJECTIVE: Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events. MATERIAL AND METHODS: We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy. RESULTS: The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities. CONCLUSION: The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation.
OBJECTIVE: Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events. MATERIAL AND METHODS: We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy. RESULTS: The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities. CONCLUSION: The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation.
Authors: Sonia Quintas; Juan Camilo Ródriguez-Carrillo; Rafael Toledano; María de Toledo; Francisco José Navacerrada Barrero; M Álvaro Berbís; Ana Beatriz Gago-Veiga Journal: Neurol Sci Date: 2017-12-18 Impact factor: 3.307
Authors: J L Restrepo-Vera; P Coscojuela; E Fonseca; M Quintana; S Sarria-Estrada; E Santamarina; L Abraira; M Sueiras; V Thonon; J Álvarez-Sabin; M Toledo; A Rovira Journal: J Neurol Date: 2022-02-13 Impact factor: 4.849