Postictal deficit mimicking stroke: role of perfusion CT

To demonstrate the use of perfusion CT in patients presenting with a suspected diagnosis of stroke to avoid the administration of inappropriate thrombolytic therapy in stroke-mimicking conditions such as status epilepticus.

We reviewed the imaging studies of four patients presenting with symptoms suggestive of stroke, but finally diagnosed with status epilepticus. Imaging was by a 16-section multidetector CT scanner using a protocol consisting of non-contrast CT, CT angiography and perfusion CT. Color-coded maps allowed calculation of the CBV (cerebral blood volume), CBF (cerebral blood flow) and MTT (mean transit time).

In all four cases, perfusion CT revealed increases in CBF and CBV as well as a decreased MTT, consistent with hyperperfusion linked to status epilepticus with focal deficit-in contrast to the hypoperfusion observed in stroke patients.

The use of perfusion CT accurately detected hyperperfusion in status epilepticus presenting as stroke. In such cases, perfusion CT imaging avoided the administration of potentially harmful thrombolytic therapy to patients experiencing seizures due to different underlying etiologies.