Abstract
BackgroundDiagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE.MethodsWe retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared.ResultsWe included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4–80.2) and a specificity of 77.8% (95% CI 57.2–90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG.ConclusionsIn acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.
Highlights
Epileptic seizures are a common reason for emergency room (ER) visits [1]
Twenty patients (42.5%) received a final diagnosis of status epilepticus (SE): nine (45%) patients suffered from NCSE with or without coma along with EEG patterns consistent with SE and 11 (55%) patients were clinically diagnosed with SE with prominent motor symptoms; 10 of these patients had a non-ictal pattern on EEG and one died shortly after CT before EEG could be performed due to concurrent fatal pneumonia from SARS-CoV-2 infection
In the present study of patients presenting with an epileptic seizure at the ER of a tertiary hospital, focal hyperperfusion on early perfusion computed tomography (pCT) was a useful marker of SE but not single epileptic seizures
Summary
Epileptic seizures are a common reason for emergency room (ER) visits [1]. Status epilepticus (SE), the most severe form of epilepsy, is a life-threatening condition [2]. Stroke and post-ictal epileptic phenomena often mimic SE without prominent motor symptoms (nonconvulsive SE [NCSE]) [4] In such cases, an electroencephalogram (EEG) is necessary to confirm diagnosis, but even at tertiary hospitals that deal with neurological emergencies, access to EEG can be delayed by 4 h or longer [5]. Regarding status epilepticus (SE), may be challenging in an emergency room setting. Of 18 patients who showed hyperperfusion on pCT, 12 were diagnosed with SE and eight had EEG findings compatible with an SE pattern. Conclusions In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely
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