Stroke mimic: Perfusion magnetic resonance imaging of a patient with ictal paralysis

Area of Science:

• Neurology
• Neuroradiology
• Neuroimaging

Background:

• Stroke mimics pose diagnostic challenges, potentially leading to misdiagnosis and inappropriate treatment.
• The

Observation:

• A patient presented with clinical signs suggestive of a stroke during the diagnostic window period.
• Initial clinical assessment led to a suspected diagnosis of acute ischemic stroke.

Findings:

• Diffusion-perfusion MRI revealed the patient's symptoms were not due to stroke but rather ictal paralysis from focal inhibitory seizures.
• This neuroimaging technique differentiated stroke mimics from actual ischemic events.

Implications:

• Diffusion-perfusion MRI is crucial for accurately diagnosing stroke mimics, such as seizure-induced paralysis.
• This diagnostic approach helps avoid unnecessary and potentially harmful thrombolytic therapy in non-stroke cases.
• Accurate diagnosis through advanced imaging prevents delayed treatment for the actual underlying condition.