J Korean Soc Radiol.  2013 Aug;69(2):89-92. 10.3348/jksr.2013.69.2.89.

Regional Cortical Hyperperfusion on Perfusion CT during Postictal Motor Deficit: A Case Report

Affiliations
  • 1Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. sartre81@gmail.com

Abstract

Postictal neurologic deficit is a well-known complication mimicking the manifestation of a stroke. We present a case of a patient with clinical evidence of Todd's paralysis correlating with reversible postictal parenchymal changes on perfusion CT and magnetic resonance (MR) imaging. In this case, perfusion CT and MR imaging were helpful in the differential diagnosis of stroke-mimicking conditions.


MeSH Terms

Diagnosis, Differential
Humans
Magnetic Resonance Spectroscopy
Neurologic Manifestations
Paralysis
Perfusion
Stroke

Figure

  • Fig. 1 A 72-year-old male with acute onset aphasia and right extremity weakness. A. Axial DWI shows subtle cortical hyperintensity in the left parietal lobe. B. ADC reveals mild diffusion restriction. C-E. Perfusion CT images demonstrate increased CBF (C) and CBV (D) in the left parietal cortices, but relatively normal configuration of MTT (E). F, G. Axial CTA source images demonstrates mild increased vascular pattern. H. Follow-up DWI on the next day shows no diffusion abnormality. I, J. Follow-up perfusion CT at one week shows complete normalization of the preexisting hyperperfusion on CBF (I) and CBV (J) maps. Note.-ADC = apparent diffusion coefficient, CBF = cerebral blood flow, CBV = cerebral blood volume, CTA = CT angiography, DWI = diffusion-weighted image, MTT = mean transition time


Reference

1. Davis DP, Robertson T, Imbesi SG. Diffusion-weighted magnetic resonance imaging versus computed tomography in the diagnosis of acute ischemic stroke. J Emerg Med. 2006; 31:269–277.
2. Mathews MS, Smith WS, Wintermark M, Dillon WP, Binder DK. Local cortical hypoperfusion imaged with CT perfusion during postictal Todd’s paresis. Neuroradiology. 2008; 50:397–401.
3. Masterson K, Vargas MI, Delavelle J. Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol. 2009; 36:48–51.
4. Hemmen TM, Meyer BC, McClean TL, Lyden PD. Identification of nonischemic stroke mimics among 411 code strokes at the University of California, San Diego, Stroke Center. J Stroke Cerebrovasc Dis. 2008; 17:23–25.
5. Weinand ME, Carter LP, el-Saadany WF, Sioutos PJ, Labiner DM, Oommen KJ. Cerebral blood flow and temporal lobe epileptogenicity. J Neurosurg. 1997; 86:226–232.
6. Moritani T, Smoker WR, Sato Y, Numaguchi Y, Westesson PL. Diffusion-weighted imaging of acute excitotoxic brain injury. AJNR Am J Neuroradiol. 2005; 26:216–228.
7. Warach S, Levin JM, Schomer DL, Holman BL, Edelman RR. Hyperperfusion of ictal seizure focus demonstrated by MR perfusion imaging. AJNR Am J Neuroradiol. 1994; 15:965–968.
8. Chan S, Chin SS, Kartha K, Nordli DR, Goodman RR, Pedley TA, et al. Reversible signal abnormalities in the hippocampus and neocortex after prolonged seizures. AJNR Am J Neuroradiol. 1996; 17:1725–1731.
9. Wiest R, von Bredow F, Schindler K, Schauble B, Slotboom J, Brekenfeld C, et al. Detection of regional blood perfusion changes in epileptic seizures with dynamic brain perfusion CT--a pilot study. Epilepsy Res. 2006; 72:102–110.
10. Szabo K, Poepel A, Pohlmann-Eden B, Hirsch J, Back T, Sedlaczek O, et al. Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain. 2005; 128(Pt 6):1369–1376.
Full Text Links
  • JKSR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr