Computed Tomography Perfusion Maps Reveal Blood Flow Dynamics in Postictal Patients: A Novel Diagnostic Tool

作者：Shelly Shahar; Maggio Nicola; Boxer Marina; Blatt Ilan; Tanne David; Orion David^*

来源：Israel Medical Association Journal, 2017, 19(9): 553-556.

• computed tomography (CT) perfusion maps
• cerebral blood flow
• epilepsy
• postictal state
• Todd's paralysis

Background: Computed tomography (CT) brain perfusion is a relatively new imaging method that can be used to differentiate patients following epileptic seizures in the setting of acute neurological deficits (e.g., hemiparesis, hemiplegia, hemianopsia, aphasia) who arrive at the emergency room with a suspected stroke.
Objectives: To evaluate brain perfusion changes in patients who had-an epileptic seizure.
Methods: We retrospectively identified 721 patients who presented at our stroke center between 2012 and 2015 with a suspected acute stroke and underwent examination thorough a stroke protocol, including cerebral CT perfusion (CTP) and CT angiography (CTA) within 8 hours from the onset of symptoms.
Results: Out of 721 patients, 25 presented with ictal electro-encephalography (EEG) findings within 24-72 hours from symptom onset without evidence of vascular occlusion on CTA. While 15 patients had to be excluded from the study due to concomitant brain pathology, we found a specific reduction in cerebral blood volume and cerebral blood flow occurring at the ictal zone, which was identified by a post hoc EEG investigation.
Conclusions: Our study shows that CTP is an easily accessible tool in emergency department setting for the detection of changes in blood flow dynamics among postictal patients. Thus, we propose the use of CTP in emergency settings to discriminate between postictal changes and acute vascular events.

• 出版日期2017-9