Crossed Cerebellar and Contralateral Thalamic Hyperperfusion in Epilepsy.

A 59-year-old man with no history of seizure, who was undergoing treatment for chronic alcoholic cirrhosis, was admitted for a fever due to cellulitis and alcohol withdrawal. A generalized seizure with left facial twitching developed after the patient lost consciousness during status epilepticus (SE). Electroencephalogram showed periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere (Picture A). The seizure stopped after intravenous administration of midazolam. Three days after SE onset, arterial spin-labeling perfusion magnetic resonance imaging, a noninvasive method of assessing the cerebral blood flow, showed hyperintense areas in the right frontal, temporal, and parietal cortices; the left thalamus (Picture B and C); and the cerebellum (Picture D). Hyperperfusions in the ipsilateral thalamus and contralateral cerebellum to the epileptic cortex have been reported (1), but our case is the first report of its presence in the contralateral thalamus. Abnormal thalamic perfusion in generalized SE might reflect propagation of ictal activity to the contralateral side of the epileptic focus in the periictal stage (2).

Picture.

The authors state that they have no Conflict of Interest (COI).