Acute Ischemic Stroke or Epileptic Seizure? Yield of CT Perfusion in a “Code Stroke” Situation.

L. Lucas, F. Gariel, P. Menegon, J. Aupy, B. Thomas, T. Tourdias, I. Sibon, P. Renou
AJNR Am J Neuroradiol. 2021-01-01; 42(1): 49-56
DOI: 10.3174/ajnr.a6925

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1. AJNR Am J Neuroradiol. 2021 Jan;42(1):49-56. doi: 10.3174/ajnr.A6925.

Acute Ischemic Stroke or Epileptic Seizure? Yield of CT Perfusion in a “Code
Stroke” Situation.

Lucas L(1)(2), Gariel F(3), Menegon P(4), Aupy J(2)(5), Thomas B(3)(2), Tourdias
T(3)(2), Sibon I(6)(2), Renou P(6).

Author information:
(1)From the Department of Neurology (L.L., I.S., P.R.), Stroke Unit
(2)Epileptology, and Clinical Neuroscience (L.L., J.A., B.T., T.T., I.S.),
University of Bordeaux, Bordeaux, France.
(3)Departments of Neuroradiology (F.G., B.T., T.T.).
(4)Neurology (??????).
(5)Institut des Matériaux Jean Rouxel, (J.A.), Union Mutualiste Retraite, Centre
national de la recherche scientifique, University of Bordeaux, Bordeaux, France.
(6)From the Department of Neurology (L.L., I.S., P.R.), Stroke Unit.

BACKGROUND AND PURPOSE: The clinical differentiation between acute ischemic
stroke and epileptic seizure may be challenging, and making the correct diagnosis
could avoid unnecessary reperfusion therapy. We examined the accuracy of CTP in
discriminating epileptic seizures from acute ischemic stroke without identified
arterial occlusion.
MATERIALS AND METHODS: We retrospectively identified consecutive patients in our
emergency department who underwent CTP in the 4.5 hours following the development
of an acute focal neurologic deficit who were discharged with a final diagnosis
of acute ischemic stroke or epileptic seizure.
RESULTS: Among 95 patients, the final diagnosis was epileptic seizure in 45 and
acute ischemic stroke in 50. CTP findings were abnormal in 73% of the patients
with epileptic seizure and 40% of those with acute ischemic stroke.
Hyperperfusion was observed more frequently in the seizure group (36% versus 2%
for acute ischemic stroke) with high specificity (98%) but low sensitivity (35%)
for the diagnosis of epileptic seizure. Hypoperfusion was found in 38% of cases
in each group and was not confined to a vascular territory in 24% of patients in
the seizure group and 2% in the acute ischemic stroke group. The interobserver
agreement was good (κ = 0.60) for hypo-, hyper-, and normoperfusion patterns and
moderate (κ = 0.41) for the evaluation of vascular systematization.
CONCLUSIONS: CTP patterns helped to differentiate acute ischemic stroke from
epileptic seizure in a “code stroke” situation. Our results indicate that a
hyperperfusion pattern, especially if not restricted to a vascular territory, may
suggest reconsideration of intravenous thrombolysis therapy.

© 2021 by American Journal of Neuroradiology.

DOI: 10.3174/ajnr.A6925
PMCID: PMC7814788
PMID: 33431502 [Indexed for MEDLINE]

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