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Ischemic Stroke ll: Pathophysiology

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...

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Related Experiment Video

Updated: Jul 26, 2026

Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury

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Uni-hemispheric hyperperfusion in the early postictal state: case report.

A Velasco Gonzalez¹, C Schülke², B Buerke³

¹Department of Clinical Radiology and Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. Aglae.VelascoGonzalez@ukmuenster.de.

|March 27, 2020

Summary

Seizures can cause unusual brain perfusion changes on CT scans, even unilaterally. This case highlights the importance of careful interpretation of perfusion maps to avoid misdiagnosis in postictal states.

Keywords:

CT perfusion Case report Hyperperfusion Seizures Stroke-mimics

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Area of Science:

Neurology
Radiology
Neuroimaging

Background:

Seizures occur in up to 4% of acute ischemic stroke patients.
Seizures can cause CT perfusion abnormalities in 78% of cases, especially with short imaging windows.
Postictal perfusion changes can be uni-hemispheric, requiring thorough analysis of perfusion maps.

Observation:

A 39-year-old male with epilepsy experienced generalized tonic-clonic seizures.
A multimodal CT scan 15 minutes post-seizure showed sharply delimited uni-hemispheric and cerebellar hyperperfusion.
The patient remained awake with no focal neurological deficits.

Findings:

This is the first report of early postictal sharply delimited uni-hemispheric hyperperfusion and rhombencephalon alteration.
CT perfusion changes were not associated with focal neurological signs.
Novel CT perfusion reconstruction using peak enhancement identified cerebral pathology.

Implications:

Radiologists and neurologists must be aware of CT perfusion map limitations in seizure patients.
Careful analysis is crucial to prevent misdiagnosis of perfusion alterations.
Understanding postictal perfusion changes aids in accurate diagnosis and management.