Abstract
Emergency medicine physicians are often faced with the challenging task of differentiating true acute ischemic strokes from stroke mimics. We present a case that was initially diagnosed as acute stroke. However, perfusion CT and EEG eventually led to the final diagnosis of status epilepticus. This case further asserts the role of CT perfusion in the evaluation of patients with stroke mimics in the emergency room setting.
Highlights
The differentiation between stroke and seizure can be a clinically arduous task for both emergency medicine physicians and neurologists [1,2]
Current guidelines advocate only Non-contrast CT (NCCT) as the imaging modality of choice in the initial evaluation of acute stroke, this case illustrates the importance of CT perfusion studies in the radiographic evaluation of brain attack patients in order to avoid misdiagnosis and inadvertent treatment of non-stroke patients with thrombolytic therapy
We describe an interesting case of a patient presenting to the Shands Hospital at the University of Florida emergency room with a homonymous hemianopsia and alterations on perfusion CT related to hyperglycemia-induced occipital status epilepticus
Summary
The differentiation between stroke and seizure can be a clinically arduous task for both emergency medicine physicians and neurologists [1,2]. Current guidelines advocate only NCCT as the imaging modality of choice in the initial evaluation of acute stroke, this case illustrates the importance of CT perfusion studies in the radiographic evaluation of brain attack patients in order to avoid misdiagnosis and inadvertent treatment of non-stroke patients with thrombolytic therapy. We describe an interesting case of a patient presenting to the Shands Hospital at the University of Florida emergency room with a homonymous hemianopsia and alterations on perfusion CT related to hyperglycemia-induced occipital status epilepticus. An EEG was obtained, and it confirmed nonconvulsive seizure activity from the right parietooccipital quadrant This patient was eligible for intravenous thrombolysis given the neurological findings and NIHSS of 2; the constellation of the above findings led to our clinical decision not to administer thrombolytics in the setting of a seizure diagnosis. Follow-up FLAIR MRI brain imaging did not reveal evidence of stroke (Figure 1)
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